Telehealth’s Persistent Challenge: Provider Payment

Telemedicine overcomes accessibility obstacles and makes health care services available to more patients. Understand the rules and regulations for providing and receiving payment for telehealth services.

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Demand for telehealth services has surged dramatically in the last year. Remote health care allowed patients to receive diagnostics and treatment without a trip to the physician’s office increasing their risk of contracting COVID-19. Providers embraced this relatively new form of medicine out of necessity, but it has proved beneficial beyond pandemic restrictions and will likely remain a significant health care alternative in future.

But collecting payment for telehealth services remains challenging. Whether direct remittance from patients, reimbursement from government programs, or payment from private insurers, the process has proved chaotic and confusing. What follows is a brief overview of telehealth payment practices and links to additional resources and guidelines.

The rise of telehealth

Telehealth — or telemedicine — is the practice of providing health care consultations when provider and patient are in different locations. It requires each party to have a suitable device and an internet connection. Patients, doctors, and/or nurses can talk with each other live, exchange messages via email and chat functions, and share files with patients or other providers for consultation purposes.

Providers can monitor patients in real-time if they are equipped with the necessary monitoring devices, such as blood pressure cuffs, glucose monitors, or EKG devices. Telemedicine can provide many types of remote care, including pain and prescription management, treatment of common and chronic conditions, post-surgical care, and behavioral or mental health counseling.

Getting paid

Telehealth services are straightforward — until it comes time to bill or receive payment. In most cases, telemedicine consultation costs are equivalent to in-person visits, but things get complicated when it comes to payer reimbursement.

For private insurers, every plan is different. Verify benefits and billing codes for telehealth services and ask about restrictions on patient location and/or reimbursement amounts. And because telehealth coverage is policy-dependent, verify beforehand that the patient’s insurance covers the particular telehealth services you provide.

For Medicare beneficiaries, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) authorizes Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) to furnish distant-site telehealth services, including office visits and preventive screenings, to Medicare beneficiaries during the COVID-19 public health emergency.

For Medicaid patients, each state establishes for which services they will reimburse providers. For patients who pay directly, be transparent about costs before providing services.

Stay up to date

Telehealth rules and regulations are constantly and quickly changing because of the pandemic, and they’re likely to continue evolving after it’s over. Reimbursement guidelines are also changing. Watch for bulletins and announcements about telehealth policies from relevant insurance payers. Find up-to-date, state-by-state information at Telemedicine policies by state and Telehealth Policy: Current state laws and reimbursement policies.

Telehealth has kept practices, hospitals, and other health facilities open and operating during the height of the pandemic, but getting paid for it is still complicated as providers and payers work out the kinks. Staying abreast of new requirements and reimbursement policies can be difficult and time-consuming. For the most cost-effective solution, consider outsourcing to a professional coding and billing company like TruBridge.

Written by Chris Johnson
TruBridge Sr. Director, Revenue Cycle Solutions