Telemedicine Facts, 2nd Edition

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Telemedicine Facts provides an in-depth look at the administrative and regulatory requirements for telemedicine operations in government health insurance programs (Medicare/Medicaid) and private health insurance plans. Due to the onset of the COVID-19 pandemic, healthcare providers rapidly shifted to adoption of telemedicine options.  Even with some lessening of the pandemic, telemedicine remains an important part of American health coverage and likely will remain so well into the future.

Key topics include:

  • How telemedicine works
  • Advantages of telemedicine vs in-person healthcare
  • Different types of telemedicine (store-and-forward, remote patient monitoring, etc.)
  • Covid-19's effect on telemedicine
  • Telemedicine's relationship with Medicare and Medicaid
  • State-by-state analysis of telehealth services available, restrictions on each service, and billing codes by state

New in this 2nd edition:

  • Live Video Medicaid Reimbursement – 50 states and District of Columbia
    Live video is the most common type of telehealth and the most predominantly reimbursed. Every state offers some type of live video reimbursement in their Medicaid program. The reimbursement varies with some Medicaid programs, limiting the types of reimbursable services and placing additional requirements and restrictions such as provider type and originating site stipulations.
  • Store-and-Forward Medicaid Reimbursement – 22 states
    Store-and-forward services are covered for reimbursement by twenty-two Medicaid Programs. Some states cover only teleradiology, and they are not included in this count. Of those covering "store-and-forward," many limit what is considered reimbursable. Some states allow store-and-forward reimbursement because of communication technology-based services (CBTS), some of which include the store-and-forward modality in its description.
  • Remote Patient Monitoring Medicaid Reimbursement – 27 states
    Twenty-seven states offer some type of reimbursement for RPM in their Medicaid programs. The states that offer RPM reimbursement generally include several restrictions for using RPM. Often seen are restrictions offering reimbursement to home health agencies, restricting the clinical conditions for which symptoms can be monitored, and imposing limits on the type of monitoring device and information that can be collected. Ohio allows reimbursement only for specific remote physiologic monitoring codes modeled after CMS reimbursement.
  • Transmission & Facility Fees
    Thirty-four states will reimburse for either a transmission, facility fee, or both.
  • Telephone Medicaid Reimbursement – 22 states
    Telephone use reimbursement is allowed in twenty-two states for some Medicaid treatments. While it varies between states, generally they reimburse specific specialties such as mental health treatment or case management. Three states allow Medicare reimbursement for audio-only interaction.
  • Facility Originating Site Restrictions -16 states
    Sixteen states restrict the "site of origin" that is covered, with several of them not allowing the home as a reimbursable site. Jurisdictions have a formal list of sites that can serve as the originating site for a telehealth encounter.
  • Home Services – 30 states and District of Columbia
    Thirty states and the District of Columbia allow reimbursement of services from the home. Twenty-nine states allow reimbursement from school-based settings.
  • Private Payer Laws – 43 states and the District of Columbia
    Forty-three states and DC have laws that govern private payer telehealth reimbursement policies. This area has experienced incredible growth over the past few years.
  • Consent Requirements – 45 states and the District of Columbia
    Forty-five jurisdictions require a type of informed consent requirement to allow telemedicine services. What is covered often varies by state with some regulating all Medicaid service, all telehealth in general, or designated areas of treatment.
Additional Information
SKU 3180022B
Publication Date May 6, 2022
ISBN 978-1-954096-47-9
Page Count 0
Author Michael D. Thomas, J.D.
Edition 2nd
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Michael D. Thomas, J.D.

Michael D. Thomas, is an author and consultant and has served as the Manager of Online Product Development and as a Senior Editor with the National Underwriter Company, a division of ALM Media. In addition, Mike has served as a consultant to the State of Ohio Department of Medicaid and as a writer for “The Digital Broker Podcast”, which focuses on insurance technology and operations. Mike currently works with a major commercial healthcare insurance company and provider of Medicare and Medicaid services. In addition to authoring 2021 Healthcare Reform Facts, Mike has also authored 2021 Social Security & Medicare Facts, and  has been responsible for the editorial process and development of other healthcare and insurance publications including Advisor’s Guide to Long Term Care 2nd Edition, Social Security & Medicare Facts, ERISA Facts, and Health Savings Accounts Facts for The National Underwriter Company as well as designing, implementing, and managing the NUPro Healthcare Reform online service. Mike has also authored numerous articles on healthcare reform, Social Security, Medicare and Insurance issues.  He has developed, hosted, and taught webinars on Healthcare Reform and Social Security, including “The Affordable Care Act and the Employer Mandate”, “The Affordable Care Act and the Cadillac Tax – Use the Delay for Your Advantage!”, “How to Successfully Navigate the Latest Changes to the Affordable Care Act”, and “The Impact of Social Security on Retirement Plans”.

Prior to joining National Underwriter, Mike spent over twenty-five years with LexisNexis®, where he was responsible for the editorial content and new product development of new online and traditional legal products, including Health Law, Insurance Law, Social Security Law, Labor & Employment Law, Family Law, as well as other legal research tools. In addition, he worked as a Field Agent for Knights of Columbus Insurance specializing in life, health, disability income, long-term care insurance as well as annuity sales.

Mike has a Bachelor of Arts from Tufts University and a Juris Doctorate from the University of Dayton.