Earlier, Telemedicine services were used to deliver healthcare services in remote areas. But in today’s healthcare system, patient needs more convenient and accessible healthcare, therefore telemedicine services are now also used to evaluate, diagnose and treat people using common technology without the need of in-person visit. But similar to other services, physicians are concerned about how to get proper reimbursement for these telemedicine services.
Since Telemedicine Industry is growing faster and faster, it is becoming more challenging for the healthcare service providers to keep up with the compliance requirements for these services. So, it’s true that getting reimbursed for the telemedicine services can be quite challenging.
Reimbursement for telemedicine services depends and varies on the basis of state, service, practice and third party payer. Medicare has made reimbursement for telemedicine services more complicated with many regulations and updates. Before claiming for reimbursement, you must properly specify the type of telehealth service provided your geographical location which includes distant and originating sites and much more. So one should know what distant and originating sites in telemedicine industry means and what are the eligible telemedicine services.
Originating sites means the site location where the patient is receiving telemedicine services. Medicare defines certain originating sites or the eligible facilities where a person can receive telemedicine service:
- Provider offices
- Critical access hospitals
- Rural health clinics
- Federally qualified health centers
- Skilled nursing facilities
- Community mental health centers
- Hospital-based or critical access hospital-based renal dialysis centers
Who are the healthcare professionals that are eligible to provide telemedicine services.
- Nurse practitioner
- Physician assistant
- Nurse midwives
- Clinical nurse specialists
- Clinical psychologists and social workers
- Registered dietitians or nutrition professionals
Any person not listed above is not eligible for the reimbursement for telemedicine services.
Medicare Rules for Proper Reimbursement of Telemedicine Services
- Patient must be in a qualifying rural area
- Patient must be at one of the originating sites.
- Service must be provided by one of the distant site practitioners.
- Technology is real-time audio-video (interactive audio and video telecommunications system that permits real-time communication between the beneficiary and the distant site provider)
- The service is among the list of CPT/HCPCS codes covered by Medicare
For year 2019, CMS has added adding two new HCPCS codes to the covered Medicare telehealth service list:
HCPCS G0513 “Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual services; first 30 minutes”
HCPCS G0514 “Prolonged preventive service(s) (beyond the typical service time of the primary procedure), in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes”
These services are expected to be added to the list of Medicare telehealth services when the final rule is published in November.
Telemedicine has significantly improved communication between doctors and their patients. Through telemedicine, physicians can easily reach individuals that need treatment without the need of in- person visit. Telemedicine is setting the stage for the future of the industry to improve quality of care and provide more options.
For more information on Telemedicine services, join us our upcoming live webinar on “Telemedicine: Coding, Billing and Compliance” which will be held on “May 23, 2019”.