It’s also true that reimbursement laws matter in ways that go beyond an individual physician’s paycheck. Generous policies can drive telehealth offerings, just as restrictions can create a financial disincentive. Specific statutes can shape telemedicine growth as well, such as encouraging specialty consults but not remote patient monitoring – depending on which service is best compensated.
So what can we expect for 2020? Nate Lacktman, partner at the Foley & Lardner law firm and Chair of its national Telemedicine & Digital Health Industry Team, has a positive outlook. “With 42 states enacting telehealth commercial insurance laws, coupled with notable expansions in Medicare and Medicaid coverage, the reimbursement landscape looks promising for virtual care services,” he told GlobalMed. “Plus, I anticipate 2020 will bring more efforts among states to update their prior telehealth coverage laws to keep pace with the industry’s growth.”
Let’s take a look at what to expect this year.
A recent Foley & Lardner survey, 50-State Survey of Telehealth Commercial Payer Statutes, examined telehealth commercial payer statutes across all U.S. states and District of Columbia as of October 2019. The authors concluded that the reimbursement landscape has notably improved in the last two years, but policies vary wildly from state to state. For instance, just 13 states require commercial health plans to cover remote patient monitoring services, while 24 states require coverage for store-and-forward (asynchronous) telemedicine.
42 states and Washington, D.C., have some type of telehealth commercial payer statute in place – but only Arkansas, Delaware, Georgia, Hawaii, Kentucky, Minnesota, Missouri, New Mexico, Utah and Virginia offer true parity for in-person and telehealth services, in which a health plan must reimburse at the same rate for virtual and in-person care. Other states have similar bills under development.
Two months ago, The Center for Medicare and Medicaid Services (CMS) released the final CY 2020 Physicians Fee Schedule. Industry leaders immediately noted a few changes:
Curious how new codes and services get added to CMS rules? You – or anyone else – can send CMS a request, whether you’re a patient, clinician, medical society, state agency director or telemedicine vendor. Just visit the CMS telehealth site for instructions on emailing your request to Telehealth_Review_Process@cms.hhs.gov and put “Telehealth Review Process” in the subject line. The deadline for 2021 consideration is Feb. 10, 2020.
Since Medicaid consists of state-specific programs, reimbursement guidelines change depending on where services are provided. All state programs cover live video telemedicine but payment for services like store-and-forward or remote patient monitoring isn’t as consistent. Just 14 states reimburse for store-and-forward, while 22 reimburse RPM services.
The Center for Connected Health Policy’s recent report State Telehealth Laws & Reimbursement Policies notes a few trends. Virtual substance use disorder services and teledentistry now qualify for Medicaid reimbursement; some new policies require documentation and security controls for telemedicine services.
A few updates:
As always, remember that telemedicine reimbursement is complex and contextually dependent on a number of factors. Before interpreting a broad state or payer policy as guaranteeing (or ruling out) coverage and reimbursement, check directly to see if a specific service in a specific location for a specific patient will be paid. But even if the reimbursement in your area is not what you hoped, take heart in the reality that policies are steadily – if gradually – expanding payment in most regions. Telemedicine ROI is more than direct revenue, but every clinician deserves to be paid fairly for their services. Build your telemedicine program now, reduce healthcare costs, and position yourself for the even brighter financial future that’s coming. Learn more.