Telemedicine Calls for Reimbursement Regulation

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November 19th, 2014

Telemedicine ReimbursementThe turn of the year has caused many of healthcare reforms unaddressed issues to resurface – one being reimbursements to Telemedicine providers. Many healthcare providers are continuing to adopt telemedicine services despite reimbursement and regulatory challenges still in the way. However, in moving forward clarity and transparency is needed. 

Currently, the shift towards implementing or developing a telemedicine program is on the rise, with 9 out 10 providers saying meaningful telemedicine services will be central to the success of their organization. While many currently offer partial or individualized telemedicine components, providers know there is potential to improve the quality of the systems in place. The importance of a quality telemedicine program is further emphasized by the role the ACA will play in penalizing providers for readmissions and hospital acquired conditions that could have been potentially eliminated or prevented if such a system was implemented.

Telemedicine's Current Regulations

The barrier remains, that regulators and insurers have made it challenging to get paid for medicine practiced outside of traditional interactions.

Today, there is only regulation in place for Medicare reimbursements to telemedicine providers. While many have come to accept this now as standard, more must be done to implement a similar system for single-payer services. The proposal of the Medicare Telehealth Parity Act this summer, hopes to align reimbursement practices for telemedicine across the board.

While 21 states have already moved to implement these parity laws to govern private insurance coverage and more than a dozen have proposed similar legislation regarding commercial insurance, providers still hope that more will follow in 2015.

The American Telemedicine Association (ATA) notes there are 55 pieces of pending legislation related to telemedicine issues. However, if any solution regarding telemedicine standards and a reimbursement framework is to work across state lines, it will need to come from the federal government.

PayerFusion has moved to join the telemedicine movement with the development of member-centric platforms and services that can be accessed on the go from anywhere in the world. In doing so, we hope to lead the way setting the standards for fairly reimbursing telemedicine providers for the value-based services they provide. To learn more about the upcoming telemedicine services available in early 2015, subscribe to our HealthInsights Newsletter here or contact a PayerFusion representative here.