Why Can't We Get Paid For Telehealth?

Why Can't We Get Paid For Telehealth?

By Samantha Lippolis, Director, Connected Care, UC Health

Samantha Lippolis, Director, Connected Care, UC Health

I hear this all the time. Well, we can. Is it everything? Is it exactly what we want? Is it easy? Not really, but what in the American healthcare system is? It’s time for clinicians, administrators, CFOs, and telehealth directors to focus on what we can get paid for. It’s time to implement and grow where we can get paid because if we keep nibbling around the edges, dabbling in this and that, wide-scale use will never come to fruition. The dream of easy, convenient care for our patients will continue to elude us.

Here are three services you can start today.

Post-op appointments, yes I know you don’t get paid for the service because it’s in the global billing period, but that’s the point. If you have a service, you cannot get reimbursed for currently, that’s low hanging fruit. Instead of asking your patient to drive to your facility, park, wait in the lobby and then see a doctor for a ten-minute appointment, how about doing a ten-minute video visit. It’s easy and an excellent patient satisfier. Start to think about other ancillary services or a global bill that are not reimbursed. Many can be transitioned to video visits.

"It’s time to implement and grow where we can get paid because if we keep nibbling around the edges, dabbling in this and that, wide-scale use will never come to fruition"

Telestroke. If you have a telestroke service and you are not billing payers, you are leaving money on the table. The Centers for Medicare and Medicaid expanded telestroke reimbursement nationwide on January 1, 2019. We know billing is never easy, but why not charge the payers for a service you are already providing.

Our nation is ravaged by the opioid epidemic, and the telehealth community has been given the opportunity to assist. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act removes the geographic requirements and adds the patient’s home as an acceptable place of service for treatment of a substance use disorder or a co-occurring mental health disorder starting July 1, 2019. When we are given the opportunity to serve, will we take it?

In addition to the specific services above, more and more states are requiring commercial payers to reimburse telehealth statewide, and some even include the patient’s home as a place of service. Many state Medicaid’s updated their rules to reimburse for telehealth services. It takes time to know your state policy, but it’s worth it. If you’re in a state where Medicaid and commercial payers reimburse, that could account for fifty percent of your patients. Would you hold back on offering other services if you knew fifty percent of carriers reimbursed? Yes, it’s complicated to know which patient has coverage, and which does not, but you do that every day when you verify benefits. Let’s start to see telehealth in the same way as other benefits. Implement where we can, bill where we can and serve our patients.

Weekly Brief

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