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The Door for Virtual Care is Open

Recent advances in reimbursement policies have paved the way for you to build a prospering telehealth line of business.

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Telemedicine is an exciting and constantly evolving technology that has been embraced by healthcare professionals all over the world. As its use continues to expand, insurance providers and states across the country are seeing the utility in telemedicine and are encompassing it in their plans.

In fact, not only have regulatory bodies embraced the use of telemedicine for providers in the states that they are licensed in, but laws are now allowing for virtual care across state boundaries. 12 state boards allow special telemedicine certifications to allow providers to practice medicine across state lines via telemedicine (AL, LA, NV, NJ, NM, OH, OK, OR, PA, TN, TX).

Below is a guide for what you need to know when seeking reimbursement for telemedicine. Please visit our comprehensive, state by state policy guide to see your state’s telemedicine insurance laws (INSERT LINK).

What You Need to Know

If a state has a private parity law in place then it requires insurers to cover a telemedicine visit as if it were in-person. 39 states have private parity laws in place that require telemedicine to be covered in the same manner and at the same rate as in-person visits. To learn more about your state’s commercial insurance coverage, please visit our state-by-state telemedicine insurance guide (INSERT LINK).

EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this new waiver, Medicare can pay for office, hospital, and other visits done via telehealth in all 50 states, including visits in which the patient is doing a real-time video appointment, from their home starting March 6, 2020. Currently, there is no end date for this waiver and Beam’s live video chat is supported. 

Prior to this waiver Medicare could only pay for telehealth on a limited basis:  when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service. 

Learn more here.

Source: Federation of State Medical Boards, July 2020 https://www.fsmb.org/siteassets/advocacy/key-issues/telemedicine_policies_by_state.pdf

Many states’ Medicaid plans are making provisions for telemedicine. Most states allow every telemedicine visit to be charged as if it were an in-person visit. That being said, some states have certain criteria that must be met in order for the visit to qualify.

For example, in Alabama, a telemedicine visit must be a synchronous, live video chat (like Beam Health’s live video chat feature) in order to be reimbursable. Few states have more restrictive rules that only reimburse for telemedicine as long as it fits the criteria of what is considered acceptable use of telemedicine. Massachusetts will only provide Medicaid coverage for telemedicine as long as it fits outpatient services such as opioid treatment (although at the time of writing this, Massachusetts House of Representatives has introduced a bill for more comprehensive telemedicine coverage in relation to Medicaid). Visit our state-by-state Medicaid guide for telemedicine to see your state’s guidelines (INSERT LINK).

Types of Telemedicine

There are three types of telemedicine that states recognize for insurance purposes: Live Video, Store-and-Forward, and Remote Patient Monitoring. Each of these services helps different providers in different ways, however, not all types of telemedicine are created equally. You’ll find that on a state by state basis, Live Video telemedicine is considered the gold standard for reimbursement. Live Video is much more prevalent, widely used, and covered by Medicaid and parity laws than both Store-and-Forward and Remote Patient Monitoring. Beam supports Live Video

Live Video telemedicine is classified as a real-time, interactive, synchronous interaction between a provider and a patient. This telemedicine offering is useful for treatment, consultations, and diagnostics.

Store-and-Forward telemedicine is an asynchronous, pre-recorded video or image that is shared over secure email or other file sharing systems. For example, Store-and-Foreward is beneficial for radiologists when they are sharing an X-ray.

Remote Patient Monitoring is the continued evolution of telemedicine. Remote patient monitoring allows providers to keep a close eye on patients through digital technology that can monitor vitals, blood pressure, and heart rate just to name a few. This provides health care professionals with valuable information regarding the patient without the patient ever leaving their home.

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$99

per clinic per month for the following EHRs
(minimum 12 months)

  • AdvancedMD
  • athenaHealth
  • Brightree
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$599

per clinic per month for all other EHRs
(minimum 12 months)

  • AdvancedMD
  • athenaHealth
  • Brightree
  • CareCloud
  • drchrono
  • GE Virence
  • Greenway Intergy
  • Greenway PrimeSuite
  • Kareo

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