Just like Electronic Medical Record (EMR) software, tele-health and mobile health technologies are rapidly growing in physicians’ delivery of top-quality patient care. Therefore, reimbursements for “virtual” medical services are now being incorporated into various medical payment regulations.
Medicare and Accountable Care Organizations (ACOs) will reimburse physicians who utilize videoconferencing and storage-and-forward applications to conduct chronic pain management and treat patients in rural regions.
Further, individual states have been pushing hard to officiate reimbursements for this type of medical care. Only about 4 or 5 states reimbursed doctors for their tele-based treatment four years ago, but now about 22 states have private insurance companies that decided to include this within the scope of their coverage.
Find out if the insurance plans that you accept as a physician will cover your patient virtual care as described above. If they do extend coverage, also find out if there are any special stipulations that need to be carried out before you file a remittance claim for this.
In some states, you are required to obtain informed consent for tele-health and mobile health treatments, meaning that you need to ensure and possibly get a written statement that the patient understands and agrees to the nature of this care. Seven or eight states have specific policies on the state of the doctor-patient relationship. There is some debate on whether physical one-on-one contact between physician and patient must be established before any virtual physician visits and other interaction could be reimbursed, or whether a physician’s relationship with the patient only through a computer or mobile device would suffice.
Medicare Provisions on Reimbursement
The Centers for Medicare and Medicaid Services (CMS) plans to include annual wellness and behavioral visits in its tele-health and mobile health coverage. Annual wellness visits in this case consist of the initial visit and follow-up visits as necessary for preventive care. Behavioral visits encompass psychoanalysis and family psychotherapy – with or without the presence of the patient. CMS also will reimburse any additional tele-health sessions needed outside of standard treatment.
Medicare mandates that physicians must establish relationships with patients so as to provide tele-medical services and receive suitable reimbursement. But that relationship doesn’t necessarily have to include an in-person meeting before tele-based treatment takes place. For example, a patient doesn’t have to drive several hours to see a physician if he or she lives in a rural area. The physician and patient simply can telecommute – depending, of course, on the nature of the medical situation.
What does tele-health and mobile health technologies mean exactly?
The Federation of State Medical Boards (FSMB) defines the concept of practicing medicine through tele-health and mobile health technologies as follows:
“Generally, telemedicine is not audio-only, telephone conversation, e-mail/instant messaging conversation or fax. It typically involves the application of secure videoconferencing or store-and-forward technology to provide or support healthcare delivery by replicating the interaction of a tradition encounter in person between a provider and patient.”
Store-and-forward applications give the physician a secure avenue to transmit medical information to the patient, such as electronic images, x-rays, MRIs, pre-recorded video exam clips, and other protected health records.
Further, mobile applications offer live video visits, e-prescribing, real-time electronic health record input by physician and patient, and a host of other convenient functionalities to monitor health conditions, such as chronic pain, illnesses, etc.
The Alliance for Connected Care conducted a research study that was released this December on physicians’ use of tele-health and mobile devices. According to their research, 83% of patients who consulted a physician through virtual visits were able to resolve their health issues. Of the other 17%, 10% needed to receive urgent care and 7% ended up meeting with the physician in person.
With the overall efficacy of telemedicine, physicians across the U.S. should be able to file claims that incorporate tele-health and mobile health services in the very near future.
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