The Problem The lack of private payer reimbursement
has been identified as on of the principle barriers restricting the
acceptance and growth of telemedicine. This perceived barrier appeared
to be based on the assumption that private payers do not pay for telemedicine
and will resist paying if asked. It was further assumed that private
payers followed the lead of Medicaid and Medicare reimbursement practices.
Finding the Solution
In order to prove or disprove the above assumptions, a survey of health
delivery organizations offering billable telemedicine services was
undertaken to determine if any receive private payer reimbursement,
and if so, what policies and procedures they use when submitting claims.
In addition, the actions that led to private payer acceptance of such
practices and the top five (5) private payers providing payments were
identified.
The Survey Process
An initial survey was sent to the approximately 2000 members of the
American Telemedicine Association (ATA). The initial response was
poor and determined that the audience was too general. To better focus
the survey, ATA and AMD Telemedicine jointly developed a list of 141
active telemedicine programs in the United States. They further defined
72 of these programs as offering potentially billable services. A
direct phone survey of these programs was conducted.
Findings
The basic assumptions proved false. It was found that more than half
of the programs (38), delivering billable services, are currently
receiving reimbursement from private payers.1 Payers are
currently reimbursing in at least 25 states. It was also determined
that, in many cases private payers are not following the lead of Medicaid/Medicare,
but are following the lead of Blue Cross/Blue Shield. There are currently
21 states in which Blue Cross/Blue Shield reimburses, where as Medicaid
reimburses in only 18 states.
- 3 telemedicine programs receive reimbursement for store and
forward
- 7 telemedicine programs receive reimbursement for facility fees
- Over 100 private payers currently reimburse for telemedicine
services (this is only a partial list)
1Of the 41 active telemedicine programs identified,
72 provide billable services, of which 38 receive private payer reimbursement.
In total, 53% of telemedicine programs offering billable services
receive private payer reimbursement
* Since many telemedicine providers, receiving private
payer reimbursement, treat the billing of telemedicine services
as usual and customary, many do not use modifiers or specialized
CPT codes for tracking purposes. Because of this, it is impossible
to accurately quantify the volume of reimbursement.
Successful Strategies
Many telemedicine programs have been successful in obtaining private
payer reimbursement by taking the following approach:
- Treating telemedicine services as usual and customary medical
practices. Actions to try to identify telemedicine consultations
as different or requiring "special" coding generally proved counter-productive
and of limited value.
- Sending letters to their private payers, to include:
- The intent to provide such services, using telemedicine as the
normal course of business
- Notification of future claim submittals
- Encouraging questions and comments from the private payer
In most instances, private payers either did not issue a response,
or responded with no requests for special coding. Customary billing
procedures were adhered to and the claims were processed and paid.
|
home : About Survey : State
Legislation : Sponsors & Contacts
