When it comes to reimbursement for telehealth and mobile health services, the details matter. As technology broadens the reach of care coverage for healthcare providers, refined considerations are coming into play for those who expect to get paid.
On a federal level, Medicare will be reimbursing physicians for chronic care management, while new ACO rules will allow payments for treatment of patients in rural areas using video and audio.
Additionally, on the state side, there has been strong movement toward authorizing payment for telehealth and mobile health service lines.
"Three or four years ago, there were a handful of states doing it. Now, private payers in about 22 states have decided that they will cover services," said Alexis Gilroy, a partner at Jones Day's healthcare and life sciences practice group.
Gilroy, who spoke during a Tuesday morning session at the mHealth Summit outside Washington D.C., detailed several areas in which the provider's use of technology helps determine whether reimbursement will be authorized:
- While Medicare links payment to the use of real-time video and audio, a few states, including Alabama and Tennessee, have expanded that definition in draft legislation to include mobile health technologies.
- Some states now have unique informed consent requirements for telehealth and mobile health.
- As many as eight states have issued new regulations and guidelines for establishing a provider-patient relationship. At issue in some areas is whether a relationship can be claimed solely through provision of a telehealth or mobile service, or whether some type of in-person interaction must first be established.
- Licensure, practice standards and ePrescribing also come into play under evolving measures.
Gilroy also noted that the American Medical Association and the Federation of State Medical Boards have been pushing for policies that would streamline such requirements.
"We're starting to see states adapt to those policies," she said, in recognition that the standard of care has not changed with the adoption of emerging technologies.
