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How-to Series
Unraveling the Mystery of Telemedicine
Reimbursement
Webinar Agenda
Intro Medicare Reimbursement Private Payer Reimbursement Case Studies in Complexity How to be Reimbursed Demo Q&A
Why do we care about telemedicine reimbursement?
Replace unpaid phone calls with billable telemedicine encounters
Lab results Medication adjustments
Increase practice efficiency See more patients without increasing overhead
Reimbursement remains one of the final barriers to widespread adoption of telemedicine. Here’s why it matters:
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What makes reimbursement so complex?
1. State regulations Is there a reimbursement mandate? What exceptions or restrictions are in place?
2. Payer nuance CMS Restrictions Different payers treat telemedicine differently
3. CPT Codes What codes to use?
Medicare Reimbursement
1. Patient location restricted Qualified healthcare facility (originating site fee) Rural area (resource)
2. Provider must be present at distant site Distant provider bills visit, provider at originating site bills facility
fee
3. What codes? Office visit + GT (ex 99202 GT) 99490 – Medicare CCM HCPS code Q3014
Private Payer Reimbursement 30 states require coverage – parity law Many plans cover telemedicine regardless of parity
law Common CPT Codes: 99201 - 99215
Some require GT modifier, others do not The only way to know is to call the payer and check a
patient’s plan…
What to look for in your state’s mandate Is the originating site restricted? (like CMS) When does the law go into effect? Other exceptions
Plan exceptions Patient relationship Type of services covered?
Case Study #1
Private payer reimbursement for telemedicine mandated in Texas
Some small employer and disease-specific health plans exempt
Texas Insurance CodeChapter 1455. Telemedicine and Telehealth
Sec. 1455.004. Coverage for telemedicine medical services and telehealth services.
(a) A health benefit plan may not exclude a telemedicine medical service or a telehealth service from coverage under the plan solely because the service is not provided through a face-to-face consultation.
Chiron Reimbursement Guarantee®
Prior patient relationship required (must have been seen in person in last 12 months)
Prior relationship restriction injunction in place as of May 2015
Texas
Private payer reimbursement for telemedicine mandated in Arizona
Originating site must be located in a rural county: Population less than 900,000 or Greater than 900,000 but more than 30 miles
from a county with population of 500,000 or more
AZ Statute, Sec. 20-841-.09Telemedicine; coverage of healthcare services
A. All contracts issued, delivered or renewed on or after January 1, 2015 must provide coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the subscriber and a health care provider and provided to a subscriber receiving the service in a rural region of this state.
Limits types of service to: Trauma, burn, cardiology, infectious
disease, mental health disorders, neurologic diseases including stroke, dermatology
Case Study #2 Arizona
Our Story
Andrew O’Hara – Founder and CEO
Founded in 2013 by two grad students at the University of Texas at Austin
Mission: To help physician practices provide convenient access to their patients through secure video visits — and receive full reimbursement.
Built with love in
Video-based telemedicine is quickly becoming the standard for many types of office visits – Chiron Health provides the tools and support to make this a no-brainer for physician practices.
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Why Chiron Health?
1. Chiron Reimbursement Guarantee®
Full private payer reimbursement, guaranteed. Insurance eligibility rules engine
2. Seamless integration into your EHR Schedule video visits exactly like in-person visits We verify your patients’ insurance and check them in virtually
3. World-class customer support We have only one job: To ensure you and your patients have a
phenomenal telemedicine experience
Questions?Request a demo to see how you can offer convenient video visits in your practice.
Visit: www.chironhealth.com