Telemedicine and Reimbursement

Advising you on the best way to structure your telemedicine services in only the first part of our counsel. Securing payment for those services is equally important. For providers with limited or no experience in securing commercial and government reimbursement for telemedicine services, arrangements other than private pay or private contracting can be challenge. While the traditional health care delivery model was historically based on a face-to-face in-person encounter between a physician and a patient, with the physician supervising any necessary additional services, including hospitalization, many remote delivery models can now provide high quality health care, including face-to-face encounters, without an in-person visit.

Payors have taken notice of the cost savings achievable through telemedicine, and states are seeking to promote the use of telemedicine in the commercial context by enacting legislation mandating that commercial payors cover telemedicine services. Our Health Care attorneys have advised clients on these issues, including the scope of these rules and informing clients of new and proposed state legislation.

Medicare’s emerging focus on “episodes of care,” rather than straight fee-for-service, as well as accountable care organizations (ACOs) that focus on integrated care, should provide leadership for a rapidly accelerating acceptance of — and payment for — telemedicine services. Indeed, Medicare’s proposed rules (slated to go into effect January 1, 2015) expand the scope of covered telemedicine services, including a notable expansion of coverage for telemedicine-based chronic care management. Similarly, a majority of state Medicaid programs offer some type of reimbursement for telemedicine services.