Telemedicine Reimbursement and Regulation: an Overview for Providers

by Snell & Wilmer
Contact

Snell & Wilmer

The advent of telemedicine supplies a unique and convenient gateway for patients and providers to connect. The benefits of telemedicine range from increased access to care for patients, to increased efficiency and lower overhead costs for providers. However, as is common with new models of health care delivery, navigating the regulatory landscape can be a challenge.

As with regulation of almost any health care delivery model, there will be aspects of compliance that involve federal regulation, state regulation, payor specific regulation, and provider specific regulation. In telemedicine, this regulatory scheme is no different.

Providers may wish to consider what regulations are applicable to their telemedicine practice by tracking enrolled patients by payor type. This may help providers assure that they are not only in compliance with applicable contractual or regulatory schemes, but could also assure that they receive reimbursement for provided telemedicine services. One way to do this is to have patients designate which payor type they will be using for their healthcare coverage on a telemedicine specific patient acknowledgement form when they sign up for telemedicine services.

Although there is not comprehensive federal regulation specific to the topic of telemedicine, the big federal player is always the regulatory body for Medicare – the Centers for Medicare and Medicaid Services (“CMS”). Medicare only reimburses telemedicine if it relates to certain types of care, provider types, locations and technology. It is advisable to consult the Medicare reimbursement guidelines for more information on what services will be reimbursed by Medicare. Even for telemedicine services that are not reimbursed by Medicare, it is possible to provide those services to a Medicare beneficiary. However, providers should have Medicare patients sign an Advanced Beneficiary Notice of Nonpayment before providing the services so the patient understands that they may be required to pay out of pocket for certain non-covered telemedicine services.

Medicaid rules on telemedicine vary from state to state. Some states provide a wider scope of reimbursement for telemedicine than Medicare, while others may have limitations similar to those of the Medicare program, such as requirements for the site location of telemedicine services (in office v. at home) or the geographic area where telemedicine takes place (urban v. rural). State specific Medicaid guidance is generally available on each state’s Medicaid website to help providers navigate the Medicaid reimbursement landscape for telemedicine.

Like Medicaid, commercial payors will have their own requirements for telemedicine reimbursement that may vary from state to state or region to region. For example, in Colorado, commercial payors are required to provide telemedicine reimbursement in the same way they provide reimbursement for any other provider visit. The first place to look for commercial payor telemedicine requirements will be the provider’s individual or practice payor contract. This contract should have terms relating to telemedicine reimbursement. From there, a provider may wish to review state legislation to see if there are any state mandated rules regarding telemedicine and commercial payors, like in Colorado.

Once a provider has reviewed the big-picture reimbursement landscape with regard to specific payors, it is important to also verify that the practice/provider is in compliance with other state rules regarding telemedicine, particularly, those involving the regulation of certain providers. For example, some states may regulate whether providers can prescribe via telemedicine, or if there are certain provider types like psychologists and nurse practitioners that can engage in telemedicine in that state. States may also have specific licensing and cross-state practice rules that relate to telemedicine. Provider specific regulations can generally be found in the medical practice acts of each state and the equivalent acts for each other profession, such as nurses, physician assistants or psychologists.

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

© Snell & Wilmer | Attorney Advertising

Written by:

Snell & Wilmer
Contact
more
less

Snell & Wilmer on:

Readers' Choice 2017
Reporters on Deadline

"My best business intelligence, in one easy email…"

Your first step to building a free, personalized, morning email brief covering pertinent authors and topics on JD Supra:
Sign up using*

Already signed up? Log in here

*By using the service, you signify your acceptance of JD Supra's Privacy Policy.
Custom Email Digest
Privacy Policy (Updated: October 8, 2015):
hide

JD Supra provides users with access to its legal industry publishing services (the "Service") through its website (the "Website") as well as through other sources. Our policies with regard to data collection and use of personal information of users of the Service, regardless of the manner in which users access the Service, and visitors to the Website are set forth in this statement ("Policy"). By using the Service, you signify your acceptance of this Policy.

Information Collection and Use by JD Supra

JD Supra collects users' names, companies, titles, e-mail address and industry. JD Supra also tracks the pages that users visit, logs IP addresses and aggregates non-personally identifiable user data and browser type. This data is gathered using cookies and other technologies.

The information and data collected is used to authenticate users and to send notifications relating to the Service, including email alerts to which users have subscribed; to manage the Service and Website, to improve the Service and to customize the user's experience. This information is also provided to the authors of the content to give them insight into their readership and help them to improve their content, so that it is most useful for our users.

JD Supra does not sell, rent or otherwise provide your details to third parties, other than to the authors of the content on JD Supra.

If you prefer not to enable cookies, you may change your browser settings to disable cookies; however, please note that rejecting cookies while visiting the Website may result in certain parts of the Website not operating correctly or as efficiently as if cookies were allowed.

Email Choice/Opt-out

Users who opt in to receive emails may choose to no longer receive e-mail updates and newsletters by selecting the "opt-out of future email" option in the email they receive from JD Supra or in their JD Supra account management screen.

Security

JD Supra takes reasonable precautions to insure that user information is kept private. We restrict access to user information to those individuals who reasonably need access to perform their job functions, such as our third party email service, customer service personnel and technical staff. However, please note that no method of transmitting or storing data is completely secure and we cannot guarantee the security of user information. Unauthorized entry or use, hardware or software failure, and other factors may compromise the security of user information at any time.

If you have reason to believe that your interaction with us is no longer secure, you must immediately notify us of the problem by contacting us at info@jdsupra.com. In the unlikely event that we believe that the security of your user information in our possession or control may have been compromised, we may seek to notify you of that development and, if so, will endeavor to do so as promptly as practicable under the circumstances.

Sharing and Disclosure of Information JD Supra Collects

Except as otherwise described in this privacy statement, JD Supra will not disclose personal information to any third party unless we believe that disclosure is necessary to: (1) comply with applicable laws; (2) respond to governmental inquiries or requests; (3) comply with valid legal process; (4) protect the rights, privacy, safety or property of JD Supra, users of the Service, Website visitors or the public; (5) permit us to pursue available remedies or limit the damages that we may sustain; and (6) enforce our Terms & Conditions of Use.

In the event there is a change in the corporate structure of JD Supra such as, but not limited to, merger, consolidation, sale, liquidation or transfer of substantial assets, JD Supra may, in its sole discretion, transfer, sell or assign information collected on and through the Service to one or more affiliated or unaffiliated third parties.

Links to Other Websites

This Website and the Service may contain links to other websites. The operator of such other websites may collect information about you, including through cookies or other technologies. If you are using the Service through the Website and link to another site, you will leave the Website and this Policy will not apply to your use of and activity on those other sites. We encourage you to read the legal notices posted on those sites, including their privacy policies. We shall have no responsibility or liability for your visitation to, and the data collection and use practices of, such other sites. This Policy applies solely to the information collected in connection with your use of this Website and does not apply to any practices conducted offline or in connection with any other websites.

Changes in Our Privacy Policy

We reserve the right to change this Policy at any time. Please refer to the date at the top of this page to determine when this Policy was last revised. Any changes to our privacy policy will become effective upon posting of the revised policy on the Website. By continuing to use the Service or Website following such changes, you will be deemed to have agreed to such changes. If you do not agree with the terms of this Policy, as it may be amended from time to time, in whole or part, please do not continue using the Service or the Website.

Contacting JD Supra

If you have any questions about this privacy statement, the practices of this site, your dealings with this Web site, or if you would like to change any of the information you have provided to us, please contact us at: info@jdsupra.com.

- hide
*With LinkedIn, you don't need to create a separate login to manage your free JD Supra account, and we can make suggestions based on your needs and interests. We will not post anything on LinkedIn in your name. Or, sign up using your email address.