What are the reimbursement issues for telehealth?
Today, not all telehealth costs are reimbursed. Medicare, which has to some extent set the standard, reimburses for telehealth services when the originating site (where the patient is) is in a Health Professional Shortage Area (HPSA) or in a county that is outside of any Metropolitan Statistical Area (MSA), defined by HRSA and the Census Bureau, respectively. This originating site must be a medical facility and not the patient's home. Medical facilities include practitioners' offices, hospital, and rural health clinics. This reimbursement is not affected by the location from which the telehealth services are being delivered (the "distant" site). Medicare will only pay for "face-to-face", interactive video consultation services wherein the patient is present. That is, Medicare will cover telemedicine services that mimic normal face-to-face interactions between patients and their health care providers. Medicare does cover store-and-forward applications, such as teleradiology and remote EKG applications, as they do not typically involve direct interactions with patients. Medicare does cover store-and-forward applications, such as teledermatology, in Alaska and Hawaii.
There is no single widely-accepted standard for private payers. Some insurance companies value the benefits of telehealth and will reimburse a wide variety of services. Others have yet to develop comprehensive reimbursement policies, and so payment for telehealth may require prior approval. Likewise, different states have various standards by which their Medicaid programs will reimburse for telehealth expenses. Check with the major insurance companies and the Medicaid program in the state to get a clearer policy perspective on coverage.
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