{"id":385,"date":"2016-10-27T15:07:19","date_gmt":"2016-10-27T22:07:19","guid":{"rendered":"https:\/\/blog.sprucehealth.com\/?p=385"},"modified":"2023-10-26T06:17:33","modified_gmt":"2023-10-26T13:17:33","slug":"4-great-ways-get-paid-telemedicine","status":"publish","type":"post","link":"https:\/\/sprucehealth.com\/blog\/4-great-ways-get-paid-telemedicine\/","title":{"rendered":"4 Great Ways to Get Paid for Telemedicine"},"content":{"rendered":"

The United States Congress recently tasked the federal Department of Health and Human Services (HHS) with producing a modern report on telemedicine, including an assessment of any barriers to\u00a0its adoption. HHS has now delivered that\u00a0report<\/a>, and the department wastes no time in it stating\u00a0plainly that “telehealth holds promise as a means of increasing access to care and improving health outcomes,” immediately thereafter identifying\u00a0reimbursement and “the payment environment for telehealth services” as the first issue standing between\u00a0telemedicine and the patients who need it.1<\/sup><\/p>\n

Telemedicine is effective, and its use is now inhibited not by technology but by policy. While money is not everything, it does keep the clinic lights on, and even the federal government is now looking for ways to pay doctors for their time\u00a0online. Though some of these gears will turn slowly, there are already some great, straightforward\u00a0ways for most doctors\u00a0to get paid for telemedicine today. Read on for four of our favorites!<\/p>\n

1) Bill Private Insurers Through Parity Laws<\/h1>\n

It’s not advertised very often, but more than half of all\u00a0states have a telemedicine “parity” law in place, which requires\u00a0private health insurers to reimburse for a telemedicine service if\u00a0they would reimburse for that same service when provided in person.2<\/sup> This can be\u00a0a fantastic way to get paid for your efforts in telemedicine.<\/p>\n

To investigate telemedicine parity laws for your specific situation, first check out the regularly updated guides from the American Telemedicine Association (ATA)\u00a0and the Center for Connected Health Policy (CCHP)<\/a>.2,3<\/sup> These reports\u00a0break the situation down on a state-by-state basis and will help you get a sense of whether your state has a parity law and what its specific limitations might be.<\/p>\n

Next, investigate the provider handbooks and contracts for the insurance companies that you deal with. These will often tell you which services are covered and how to bill for them. Telemedicine services are often reported using in-person CPT codes with an appended HCPCS modifier: “GT” for synchronous (live video)\u00a0telemedicine and “GQ” for asynchronous (“store and forward”) telemedicine.<\/p>\n

Sometimes parity laws fail to mandate equal pay for telemedicine services, and some parity laws include exceptions that may allow insurers to sidestep the spirit of the law, such as California’s provision that parity is “subject to the terms and conditions of the [insurance] contract.” However, these laws will likely allow you to collect on real bills for at least some of your patients, and you should give them a shot!<\/p>\n

2) Disregard Medicare, Acquire Medicaid<\/h1>\n

The current Medicare telemedicine reimbursement policies<\/a>\u00a0are stifling at best.4<\/sup> Unless you are seeing patients who are in a rural area (and also in\u00a0a clinic or other approved medical facility) over a live video link for one of a short list of services, you will almost certainly not be collecting money from Medicare for telemedicine. This will\u00a0be changing, at least in part, with the new MACRA legislation, but it has not changed yet.<\/p>\n

Medicaid programs, on the other hand, are often much more progressive and have been so for years. The\u00a0ATA\u00a0and\u00a0CCHP\u00a0guides can tell you the exact situation in your specific state, but on the whole, 48 states provide some type of Medicaid coverage for telemedicine.2<\/sup>\u00a0While details vary by jurisdiction, policies are almost always more permissive than those of Medicare:\u00a036 state Medicaid programs, for instance, permit patients to participate in telemedicine visits from their homes.<\/p>\n

You may not be\u00a0seeing Medicaid patients in your\u00a0practice right now, but your state’s telemedicine laws and initiatives might mean that doing so via telemedicine would be not only viable but smart.<\/p>\n

3) Charge out of Pocket but Less Than a Copay<\/h1>\n

For years, the idea of charging patients out of pocket for most services\u00a0would have been\u00a0laughable. Coverage was broad, and copays were minimal or nonexistent, at least for those with medical insurance.<\/p>\n

Now, however, there is an ongoing shift toward higher deductibles, more\u00a0coinsurance, and increased\u00a0out-of-pocket patient financial burden<\/a>\u00a0in general. In the current climate, a typical copay for a primary care visit ranges from $20 to $40, while the copay for a specialist visit is more often $30 to $80.5<\/sup><\/p>\n

Given this situation, if you can make your telemedicine services available for $40 to $80 per encounter, you will be very attractive\u00a0to\u00a0a large chunk of patients who won’t be losing any money by skipping\u00a0their insurance when they see you.\u00a0They’ll be paying\u00a0the whole bill, but it will still be less than they’d pay out of pocket for a traditional visit, once you factor in the effects of their copay, coinsurance, and deductible.<\/p>\n

This strategy will also rid you of paperwork duties and fights with insurance companies over\u00a0reimbursement claims, both of which\u00a0have tangible monetary benefits. And, for a final bonus, you will be a valuable resource\u00a0for uninsured patients, who depend on transparent and reasonable service pricing.<\/p>\n

4) Go Concierge Lite<\/h1>\n

If you don’t want to\u00a0worry about billing for each specific telemedicine encounter, you can instead\u00a0add a “concierge lite” layer to your current practice. In this model, patients on your panel would pay a concierge retainer fee (monthly or yearly) to have access to you for telemedicine visits. On platforms like the one we offer through Spruce<\/a>, you can also easily make other features available to sweeten the deal, such as the ability to securely message with your office staff.<\/p>\n

The “concierge lite” approach\u00a0allows you to explore both telemedicine and the world outside of insurance-based fee-for-service without necessitating\u00a0a jarring overhaul of your current practice. With the right platform (*cough* Spruce *cough*), you won’t have to sign a\u00a0long-term contract or pay any onerous\u00a0fees, so you’ll have\u00a0a safe and easy way to dip your toes into the telemedicine waters and leave if you don’t like it.\u00a0If you have a few patients that you think might be excited by telemedicine in a concierge format, then this approach almost couldn’t be easier to try. Give it a shot!<\/p>\n

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References:<\/p>\n

    \n
  1. Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation (ASPE). Report to Congress: E-health and Telemedicine<\/i>. (U.S. Department of Health and Human Services (HHS), 2016).<\/li>\n
  2. Thomas, L. & Capistrant, G. State Telemedicine Gaps Analysis: Coverage and Reimbursement (2016)<\/i>. (American Telemedicine Association (ATA), 2016).<\/li>\n
  3. Gutierrez, M. & Center for Connected Health Policy (CCHP). State Telehealth Laws and Medicaid Program Policies (August 2016)<\/i>. (Center for Connected Health Policy (CCHP), 2016).<\/li>\n
  4. Medicare Learning Network. Telehealth Services (calendar year 2016)<\/i>. (Centers for Medicare & Medicaid Services (CMS), 2015).<\/li>\n
  5. Rae, M. et al.<\/i> Patient Cost-Sharing in Marketplace Plans, 2016. The Henry J. Kaiser Family Foundation<\/i> (2015). Available at: http:\/\/kff.org\/health-costs\/issue-brief\/patient-cost-sharing-in-marketplace-plans-2016\/. (Accessed: 25th October 2016)<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    The United States Congress recently tasked the federal Department of Health and Human Services (HHS) with producing a modern report on telemedicine, including an assessment of any barriers to\u00a0its adoption. HHS has now delivered that\u00a0report, and the department wastes no time in it stating\u00a0plainly that “telehealth holds promise as a means of increasing access to care and improving health outcomes,” immediately thereafter identifying\u00a0reimbursement and “the payment environment for telehealth services” as the first issue standing between\u00a0telemedicine and the patients who need it.1<\/p>\n","protected":false},"author":1,"featured_media":463,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"slim_seo":{"title":"4 Great Ways to Get Paid for Telemedicine - Spruce Blog","description":"The United States Congress recently tasked the federal Department of Health and Human Services (HHS) with producing a modern report on telemedicine, including a"},"footnotes":""},"categories":[3],"tags":[19,5,4],"different-template":[],"class_list":["post-385","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-telemedicine","tag-reimbursement","tag-telehealth","tag-telemedicine"],"acf":[],"_links":{"self":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/posts\/385","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/comments?post=385"}],"version-history":[{"count":0,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/posts\/385\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/media\/463"}],"wp:attachment":[{"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/media?parent=385"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/categories?post=385"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/tags?post=385"},{"taxonomy":"different-template","embeddable":true,"href":"https:\/\/sprucehealth.com\/blog\/wp-json\/wp\/v2\/different-template?post=385"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}