Telehealth Medicaid and Medicare Reimbursement
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As telehealth continues to have rapid growth and is finding its place within our healthcare system, most providers are left with the decision of including telehealth services within their coverage. Being based on a multitude of points such as the consumer’s location and plan, knowing the reimbursement guidelines for Medicaid and Medicare is very important. An article from OpenMinds addresses the rules:
Medicare reimbursement has three distinct sections in which a person can fall into. As stated in the article, each section yields its own coverage of telehealth services:
1) Medicare FFS in the 48 continental states:
Provider organizations are limited to providing telehealth services via two-way real time audio-visual communication to individuals at health care facilities in rural areas.
2) Medicare FFS in Hawaii or Alaska:
Telehealth reimbursement is expanded to include asynchronous store-and-forward technology. Telehealth services are still restricted to rural areas and limited to a handful of services.
3) Next Generation ACOs and Bundled Payment Initiatives:
Both these demonstration programs waiver some of the Medicare FFS telehealth requirements. Individuals may reside in any area of the country, not just rural areas and telehealth services can be delivered to individuals in their homes instead of health care facilities.
Medicaid has a host of different programs that are optional for each state. With 51 diverse policies, the states are to decide to include and outline, “…what services are covered via telehealth, what types of technology can be used, and where services can be delivered.” All but three states (Rhode Island, Massachusetts, and Connecticut) have adopted telehealth into their Medicaid programs through the “two-way real-time audio-visual communication” route.
While real-time audio-video communication coverage is widely covered, store-and-forward telehealth (covered in 13 states) and remote patient monitoring (covered in 17 states) are still waiting to be adopted into more Medicaid reimbursement plans around the nation.
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