Reimbursement

Reimbursement Overview

The absence of consistent, comprehensive reimbursement policies is often cited as one of the most serious obstacles to total integration of telehealth into health care practice.  The lack of an overall telehealth reimbursement policy reflects the multiplicity of payment sources and policies within the current United States health care system.  The vast majority of health care costs are paid by private insurers, Medicare, and Medicaid.

 

Medicaid Reimbursement

CTeL conducted a 50 state survey which reviewed each state’s telehealth reimbursement policies.  CTeL’s research found that 39 states have some type of reimbursement for services provided via telehealth.

There are many factors that states use to determine the scope of coverage for telehealth applications, such as the quality of equipment, type of services to be provided, and location of providers (e.g., remote rural sites).

 

Medicare Reimbursement

Medicare is the federal health insurance for America’s senior citizens.  Most of the financing and reimbursement for telehealth services comes from Medicare.  The expansion of Medicare reimbursement began when Congress passed the Balanced Budget Act of 1997 (BBA), which mandated that Medicare reimburse telehealth care and fund telehealth demonstration projects.

How to Determine If Your Site Is “Rural”

CMS has provided regulatory definition of “rural HPSA” for purposes of determining eligibility for Medicare telehealth originating sites to include HPSAs located in rural census tracts, consistent with the Office of Rural Health Policy/Health Resources and Services Administration (HRSA).

HRSA has developed a tool that will help providers determine geographic eligibility for Medicare telehealth services. This locator checks both the HPSA and MSA designations.