Posted: April 29th, 2018

Telehealth policy and reimbursement – analyzing the policy gaps

Telehealth policy and reimbursement – analyzing the policy gaps

Telehealth is the use of electronic information and communication technologies to deliver health care services and education when the provider and the patient are not in the same physical location. Telehealth can improve access, quality, and efficiency of health care, especially for rural and underserved populations. However, telehealth also faces several policy challenges, such as reimbursement, licensure, privacy, and quality standards.

One of the major policy gaps in telehealth is the lack of consistent and adequate reimbursement for telehealth services across different payers and settings. Reimbursement policies determine how much and under what conditions health care providers are paid for delivering telehealth services. Reimbursement policies can affect the availability, adoption, and sustainability of telehealth programs.

Currently, there is no uniform federal policy for telehealth reimbursement. Medicare, Medicaid, and private insurers have different rules and requirements for covering and paying for telehealth services. Moreover, state laws and regulations vary widely in terms of defining telehealth, setting payment parity, and mandating coverage. These variations create confusion, uncertainty, and administrative burden for telehealth providers and patients.

Some of the key issues that need to be addressed in telehealth reimbursement policy are:

– Eligible services: What types of services can be delivered via telehealth and qualify for reimbursement? For example, Medicare only covers certain services that are considered clinically appropriate to be furnished remotely, such as office visits, psychotherapy, and consultations. Medicaid and private insurers may cover a broader range of services, such as remote patient monitoring, chronic care management, and behavioral health interventions.
– Eligible providers: Who can provide telehealth services and receive reimbursement? For example, Medicare limits the types of providers who can bill for telehealth services to physicians, nurse practitioners, physician assistants, and certain other practitioners. Medicaid and private insurers may allow more types of providers to offer telehealth services, such as pharmacists, physical therapists, and social workers.
– Eligible sites: Where can telehealth services be delivered and received? For example, Medicare requires that the patient must be located in a rural or medically underserved area and at an authorized originating site (such as a hospital, clinic, or nursing home) to be eligible for telehealth reimbursement. Medicaid and private insurers may not have these geographic or site restrictions and may allow patients to receive telehealth services at home or other locations.
– Payment parity: How much are telehealth services reimbursed compared to in-person services? For example, some states have enacted laws that require payment parity for telehealth services, meaning that telehealth providers must be paid at the same rate as in-person providers for the same service. Other states do not have payment parity laws or leave the payment rates to be negotiated between providers and insurers.

To address these policy gaps and promote the adoption and integration of telehealth into the health care system, some possible solutions are:

– Developing a national framework for telehealth reimbursement that establishes minimum standards and guidelines for payers and providers.
– Expanding the coverage and payment for telehealth services under Medicare to include more services, providers, sites, and patients.
– Encouraging state-level reforms that align telehealth reimbursement policies across Medicaid and private insurers and ensure payment parity for telehealth services.
– Supporting research and evaluation on the cost-effectiveness, quality, and outcomes of telehealth services to inform policy decisions and best practices.

References:

– Telehealth policy | Telehealth.HHS.gov
– Telehealth/Virtual Health Policy, Professional – UHCprovider.com
– help write my research essay on Private insurance coverage for telehealth | Telehealth.HHS.gov
– State Telehealth Laws & Reimbursement Policies – State Summary Chart …
– Billing for telehealth | Telehealth.HHS.gov

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