How Do Medicaid, Medicare and Private Insurance Reimburse for Telehealth?
Summary: How does private insurance reimburse for telehealth? Telehealth is rapidly increasing in popularity. The major challenge is the varying methods of reimbursement — if they exist at all.
Telehealth is the ability to assess and prescribe treatment remotely. It allows the physician to use specifically designed equipment to “meet” with the patient via a computer screen. Telehealth has many advantages, such as eliminating travel time for the patient, reducing healthcare costs, and providing accessible care right in the patient’s home.
How Medicaid, Medicare, and Private Insurance Reimburse for Telehealth
Most healthcare costs are paid by Medicaid, Medicare, and private insurers. Within these realms, many different reimbursement policies have been put in place. Medicare is federal insurance for senior citizens and, therefore, telehealth policies and provisions are consistent among Medicare beneficiaries. Medicaid and private insurance are coordinated at the state level and may have a wide range of telehealth policies. Some states provide more reimbursement than others and apply different eligibility requirements. Examples of variation include:
- Coverage for specific health issues, such as mental health
- Coverage if the rationale for using telehealth meets the approval of the agency
- Coverage for specific populations, such as those living in rural health areas
- Coverage only if the service could not have been provided in person
Consistency is key. Currently, it is almost like a dartboard or a roulette wheel as to how reimbursement in general — and telemedicine in particular — is paid. The amount of reimbursement within individual states is largely a factor of budget: those with higher budgets are more likely to reimburse at a higher rate than those with lower budgets. This inconsistency is stifling the telehealth movement. So where do we go from here? One solution is federal funding or grants. Another is to create reimbursement ranges that all states would have to adhere to — perhaps set in relation to Medicare rates.
Although telehealth is moving forward, reimbursement is inhibiting the rate at which it does so. Until CMS places emphasis on the value of telehealth and makes reimbursement a primary focus, telehealth will continue to expand slowly and inconsistently. The ability to provide timely and appropriate care for patients will remain an issue, especially for those in rural areas where access to physicians is limited.
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