We did some digital health research and identified four key requirements for the adoption of digital health solutions. In a series of panel discussions, we’ll explore each of these questions in more detail.
Part II: Will I receive payment?
Join us for the second discussion where we’ll cover questions around the cost-effectiveness and payment of digital medicine. Learn about the latest trends in digital health payment, current barriers to reimbursement, and how physicians and practices are navigating this space and getting paid for the use of digital health tools.
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A: The current landscape for digital health reimbursement has never before been more favorable. We have seen a robust expansion of states enacting laws that require commercial health plans to cover medical services delivered via telehealth technology (currently approx 36 states have these laws). And CMS just announced what may be the largest expansion in history to cover virtual care services under the Medicare program. The hard work of digital health advocates is starting to really bear fruit.
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Yes. There has been progress in billing and reimbursement for telemedicine service as well as for forms of remote patient monitoring. More and more payers are covering these services. Many states have passed “parity” laws requiring payers to reimburse telemedicine services at the same rate as they pay for the same service in an in person office visit.
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Here's an article on the new Medicare expansion to cover virtual care services, which includes not only audio-video telehealth services in rural areas, but also non-face-to-face services such as asynchronous dermatology and email-style quick "virtual check-ins" to see if a patient even needs an in-person exam or more robust E/M: healthcarelawtoday.com/2018/07...
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And it does not stop with telemedicine. Medicare already covers remote patient monitoring (RPM) under CPT 99091, but that was an early-start (almost a test run) this year. The new set of RPM codes developed last year by AMA were adopted by CMS, and CMS has proposed to cover those service codes starting in 2019. Here's an article discussing those new codes in depth: healthcarelawtoday.com/2018/08...
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David is correct, and to his point, there is a subset of states with telehealth insurance coverage laws that ALSO require the health plan to reimburse the provider for services delivered via telehealth at the same reimbursement rate that health plan pays that provider for the identical in-person service. These are "payment parity" laws and work hand-in-hand with telehealth coverage laws. Here's an article discussing the difference between the two, and explaining why payment parity is almost as important as broad coverage. healthcarelawtoday.com/2015/08...
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Another article on why this all matters: healthcarelawtoday.com/2015/08...
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Here's a case study from New York on what happens when a state passes a great telehealth coverage law, but fails to include a "payment parity" provision: healthcarelawtoday.com/2016/06...
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Kentucky was in the same unfortunate situation as New York, but KY's legislature and governor recently signed into law a new telehealth insurance law, addressing and remedying these issues. This article dissects the what, why, and how of the new Kentucky law, and the lessons other states can learn from it: healthcarelawtoday.com/2018/05...