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Telemedicine Payment Models

Posted: October 24, 2021

Telemedicine offers numerous benefits. In addition to making it possible for providers to see more patients in less time, telehealth services significantly reduce the amount of no shows and last minute cancellations. Despite these and other benefits, many providers still haven’t implemented a telehealth solution. This is unfortunate, as healthcare providers that do not adopt telehealth may find it difficult to attract new patients in the future. Telemedicine is quickly becoming the preferred choice among patients of all ages.

Reimbursement was originally believed to be one of the biggest hurdles preventing widespread adoption of telemedicine. However, what many healthcare providers may not realize is that most insurance policies now cover telemedicine services. In fact, forty states now have parity laws that ensure coverage for certain telehealth appointments. Healthcare providers considering implementing a telemedicine solution could benefit from researching state laws and speaking with the healthcare plans they partner with about telehealth reimbursement.

In addition to learning about insurance reimbursement, providers should set up a properly planned and executed billing and payment policy prior to implementation. This is the best way to ensure an impressive return on investment.

Concierge or Direct-Pay Services

Practices that offer concierge or direct pay services simply need to figure out which services to offer and how much to charge for them. While some practices charge the same for telemedicine visits as in-person appointments, others may choose to charge more for the added convenience. Practices that take on several telehealth appointments each day may be able to reduce the cost of appointments and still see a significant ROI.

Private Payer Coverage

Most of the major health insurance companies offer some form of coverage for telemedicine services. It’s strongly recommended that healthcare providers contact the health plans they partner with to learn about telemedicine reimbursement. In addition to the coverage offered by these companies, many states now have parity laws that require private payers to reimburse certain telehealth appointments.

Medicaid Telemedicine Reimbursement

Each state has different guidelines for Medicaid reimbursement. Depending on the location of the healthcare practice, Medicaid might cover certain telemedicine services. Healthcare providers interested in offering telemedicine services should check their state’s Medicaid guidelines.

Offering Telemedicine on a Cash-Pay Basis

Practices that offer in-person healthcare appointments following a traditional reimbursement model may choose to offer telehealth services on a cash-pay basis. It’s not uncommon for patients to select this service for the added convenience. Providers often see impressive revenues. However, it’s important to note that healthcare providers offering telehealth services on a cash-pay basis should have their patients sign a waiver stating they will not use their insurance to pay for telehealth visits.

Final Thoughts

When it comes to increasing comfort and accessibility of healthcare, telemedicine offers an excellent option for both patients and providers. However, healthcare providers looking to implement a telehealth solution should take the time necessary to develop an effective payment model.

Let’s Talk Interactive offers telemedicine solutions to healthcare providers looking to reduce costs and increase accessibility to care. Please contact us for more information about our secure video conferencing telemedicine platform.