INTRODUCTION

Certain payors will reimburse for tele-health services equal to office visits while others may not or have certain requirements.

Currently, there are 33 states that have parity laws that mandate private payer reimbursement for telemedicine services. Typically, these mandates only cover real-time videoconferencing, but there are few states that cover store-and-forward technology.

In addition to limiting services and methods of telemedicine care delivery, Medicare has several other requirements that patients and providers must meet in order to be reimbursed through Medicare for telemedicine. To learn more about these requirements, visit the American Telemedicine Association

You may also visit the Center for Connected Health Policy to learn more about patient and provider requirements that determine reimbursement. Additionally, they provide in-depth information on legislation for both public and private healthcare programs and is a fantastic resource for those looking to dive deep into individual state policy.

Medicare

Medicare currently pays for telehealth services, but with a major asterisk. They are required to be provided only in rural or in provider shortage areas and must be provided at certain types of facilities. Medicare does allow telehealth services for CCM (chronic care management) and RPM (remote patient monitoring) to be paid for regardless of patient or provider location. And now they are also allowing demonstration projects for ESRD (end stage renal disease) patients to provide telehealth services irrespective of their location

Medicaid

Medicaid allows for all tele-health services in 49 states. Refer to the CCHP website for state-specific details

Private Pay

Parity laws allow for providers to be paid at the same rate irrespective of whether services are provided by telehealth or in-person. Parity laws are equalizing payments with traditional practice. Each provider must review their private payor contracts to determine what services are eligible for telehealth.

Footnote: A map of state parity law status around the country.

Capitated Pay

Telehealth is a very useful tool to decrease cost of care for capitated providers while still providing significant improvement for access to care of patients.

Self Pay

Direct pay providers may charge patients their own custom rates for concierge care.