The Telehealth Professional’s Guide to Successful Program Development is a blog series that provides an overview of the program development plan created by the California Telehealth Resource Center and the consortium of Telehealth Resource Centers. Phases include Assess & Define, Develop & Plan, Implement & Monitor. This plan, combined with national and regional resources, can help you build a successful telehealth program. Click here to read the entire series.
Click here to access the Step-by-Step Telehealth Program Development Checklist.
In the last few steps, you have been developing the needs assessment for your potential telehealth program. This assessment allows you to establish parameters around services you are likely to provide, clarify assumptions and identify constraints to the implementation of your program. The next step is to drill deeper into the needs assessment and identify the payer base for your planned telehealth program. The ability to obtain reimbursement for your services is vital to the success of your program.
What do you need to know?
- 29 states and the District of Columbia have parity laws that require private payers to reimburse for telehealth services that are comparable to face-to-face services
- Most of these laws do not have compliance dates, which means that some payers are not compliant with parity regulations
- Three major payers for telehealth services include Medicaid, Medicare and commercial/private payers
- Medicaid provides telemedicine reimbursement in 48 states and the District of Columbia; however, coverage varies by state
- Medicare is restrictive on telehealth reimbursement, but this may change as telehealth becomes an option for seniors
- Commercial insurance/private payers provide telehealth reimbursement that varies by state and region
- States can create their own telehealth requirements for private insurance; currently 32 states have some kind of private payer policy
- Reimbursement may be impacted when delivering telehealth services across state lines
What do you need to consider?
- Have you researched telemedicine reimbursement laws for your state as they relate to the services you want to offer?
- Have you reviewed patient data to develop a current payer breakdown – Medicaid, Medicare, Commercial/Private Payers and Self Pay?
- Have you contacted your most common commercial/private pay insurers to inquire about reimbursement policies and any restrictions, such as types of services you may deliver, technology or originating site requirements?
- Have you contacted your state health department and reviewed Medicaid and Medicare reports to understand Medicaid and Medicare spending by county for the region you serve?
Resources to get you started!
- National Telehealth Resource Center Program Development Guides – Payer Mix (1.16)
- Virtual Reality: More Insurers are Embracing Telehealth
- State Coverage for Telehealth Services
- State Telehealth Policies and Reimbursement Schedules
- Telehealth Reimbursement Fact Sheet
- Pending Telehealth Legislation and Regulation by State