Telemedicine Reimbursement

Telemedicine is a great way to improve your practice’s workflow and increase patient satisfaction, but it’s also a great way to increase reimbursement. Of course, as with most things related to healthcare billing, it can be a little nuanced and require some work on the part of your staff to make sure you get it right. But when you do, it’s a great way to improve your practice’s bottom line while also providing excellent care to your patients. Let’s take a high-level look at how it works.

Choose the type of telemedicine you’ll be using

There are several types of telemedicine available, with four of them being the most popular at this time. Those four applications are live video, store and forward video, remote patient monitoring, and mobile health. Each of these applications has use cases that make the most sense for them, and the type of application you implement for your telemedicine will affect how you bill and receive reimbursement, no matter if your patient uses Medicare, Medicaid, or a private payer.

Tips for Medicare

When billing for telemedicine services provided to Medicare beneficiaries, one of the first things you’ll need to do is define your sites, both originating and distant. Medicare does reimburse for services that were provided through telemedicine by a provider who is located at a distant site to a patient located at an originating site, but only if the originating site is in a Health Professional Shortage Area (HPSA). Originating sites within an HPSA that are authorized include:

• medical practices
• hospitals and critical access hospitals
• rural health clinics
• federally qualified health centers
• renal dialysis centers (hospital-based only)
• skilled nursing facilities
• community mental health centers

Next, it’s important to be sure to use the right codes and modifiers for telemedicine. Medicare has a list of codes that are acceptable for use with telemedicine. It’s a good idea to keep this list handy when billing in order to do so properly and also to check for updates regularly. When billing for telemedicine through Medicare you also must use the modifier GT. Finally, remember that if your facility is the originating site you’re able to charge a facility fee for hosting the visit. While all of this seems like a lot to keep straight, the good news is that Medicare’s rate for telemedicine reimbursement is the same as the rate that is paid for comparable services that were provided in person, so the work is well worth it.

Tips for private payers

Each private insurance payer handles telemedicine reimbursement a little differently, so there really aren’t any universal rules for billing telemedicine through private payers. That being said, the best rule of thumb when dealing with private payers is to seek out the information ahead of time. Make sure that you find out what’s covered through each payer you accept and how they need you to bill for it in order to be appropriately reimbursed. Finally, it’s always a good idea to verify each patient’s insurance coverage prior to providing any service, and telemedicine is no different.

Tips for Medicaid

If you accept Medicaid in your practice, you’re aware that it’s almost always changing. For this reason you’ll want to make sure that you’re consistently up to date with the latest regulations regarding telemedicine provided to Medicaid beneficiaries in your state. Make sure that your billing staff is well versed in how to work with Medicaid and emphasize the importance of knowing how to find information when they aren’t sure about billing for a service. Communication is key when it comes to Medicaid.

Telemedicine is an exciting new opportunity for providers to improve health outcomes for their patients conveniently, but as with every other service provided in your practice, it’s important to get paid for it. Before you can start billing for telemedicine, though, you have to start providing it, and for that you need the right tools. Enter medpod. Medpod combines high-definition video, multi-stream audio, and data from professional grade medical devices to cover all bases of telemedicine to get your practice up and running.

Are you ready to learn more about this best-in-class software? Henry Schein Solutions Hub can help. Call 833-433-2482 or visit for more information.