Page 26 - Part 2 Introduction to Telemedicine

SVMIC Introduction to Telemedicine

services are valued and compensated within the totality of the

healthcare economy. The following discussion has the limited goal
of providing a general orientation to the issues surrounding

payment, at the time of writing.

The payment landscape for telemedicine today is largely unsettled.

A number of fast growing services have built their businesses

entirely on direct patient payment or subscription models. Some
self-insured employers were early adopters of telehealth benefits

for their employees and provided telehealth coverage in
conjunction with select providers. Some offered a single, per visit

fee, and some created more complex tables of services and

payments, including patient incentives in the form of reduced co-
payments.

While a large number of private payers have implemented or are
considering implementing payment mechanisms for telemedicine

under many different models, the example of Medicare serves to

illustrate some of the variables in play.

Under Medicare rules, telemedicine is eligible for reimbursement if

it is provided at a “qualified site” where the patient is located. State
Medicaid programs tend to follow this guideline, and additionally

recognize (or don’t recognize) telemedicine services in a myriad of

ways.

Medicare

Medicare covers telemedicine visits under limited circumstances.

The beneficiary must reside in a health professional shortage area
or outside of a metropolitan statistical area. CMS frequently

changes its coverage policies. Providers need to study and

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