Previously, Medicare’s rules and requirements for reimbursement of healthcare providers for services delivered through telemedicine were very stringent and only limited to a few types of health services.
During the last few years, owing to the expansion of telemedicine, Medicare has extended the list of telemedicine services that they reimburse; however, there are still many rules for how these services need to be provided, in order to meet their criteria for reimbursement.
The following are a few key points of information regarding Medicare and Telemedicine.
Rules for determining Originating and Distant Sites. Medicare provides reimbursement for telehealth services that providers offer from a Distant Site to patients at an Originating Site.
As per the law, Originating Sites can be any of the following:
Hospitals
Offices of physicians or healthcare practitioners
Critical Access Hospitals (CAH)
Rural Health Clinics
Federally Qualified Health Centers
Skilled Nursing Facilities (SNF)
Hospital-based or CAH-based Renal Dialysis Centers
Community Mental Health Centers (CMHC).
The patient needs to be located in an HPSA. According to Medicare’s rules for reimbursement, not only must the beneficiary receive care virtually at one of the Originating Sites specified above, but this setting must also be situated in a Health Professional Shortage Area (HPSA).
Facility fee eligibility. Along with reimbursing services provided via telemedicine, Medicare also pays a facility fee to the originating site. For instance, primary care providers who are dealing with a patient in person, and decide to conduct a telemedicine consultation with a physician present in another location, can submit two separate bills for reimbursement – one for the telemedicine service they provided, and the other for a facility fee (for hosting the virtual visit).
Eligible healthcare providers.
As per the rules of Medicare, only the following providers may offer care through telemedicine:
Physicians
Physician Assistants
Nurse Practitioners
Nurse Midwives
Clinical nurse specialists
Clinical Social Workers
Clinical Psychologists
Registered dietitians or nutritionists.
Telehealth types.
Medicare provides reimbursement solely for live telemedicine, which involves real-time interaction between a healthcare provider and a medical beneficiary (patient) through a protected, private video chat. This sort of virtual visit serves as a substitute for an in-person consultation.