The federal government, state governments, and private insurers are examining the efficacy of telehealth.  Benefits available to the insured populations as well as the reimbursement to practices for providing these services are impacted.

What are the concerns?

Quality of care is a big concern.  Although studies are underway and some lead to the conclusion that telehealth increases access to care, the skills of clinicians using video and audio equipment for clinical work are not standardized.  Continued assessment of services, clinicians’ abilities, and therapeutic value for patients receiving these services is needed.

People of color, older people and those living in rural areas where internet connectivity is not readily available or dependable are more likely to take advantage of telephone-only services.  These populations often have difficulty accessing healthcare, in general.  Offering audio-only services in these situations can positively impact health.

On the other hand, audio-only services present unique issues. Privacy is a serious concern.  There is no way to be sure that the patient is alone, and if the patient is distracted – doing other things – during the session.  With video services, this is much less of a concern.

HIPAA has taken a back seat during this crisis, but it is a serious consideration as payers and regulators look to the future.

How should telehealth be reimbursed?

For now, many payers are paying similar rates for in-person and telehealth visits.  This is being hotly debated on all levels.  Should payers spend the same money on services they don’t believe are offering the same quality of care?  Conversely, should they pay the same reimbursement to improve access to healthcare for vulnerable populations? Payers differ in how they are treating reimbursement, currently.  Some are paying a reduced fee for telehealth services. We must wait and see how this will be handled in the future.

For the Country:

The Digital Divide is a factor that needs to be addressed.  The gulf between those with easy access and ability to use digital technology is a socio-economic and serious health issue.

What does this mean to me?

It is important to be aware of each patient’s unique benefit package.  Depending on the payer, they may have equal benefits for video/audio only services, or the benefits may not cover telehealth services.  Some payers will only cover telehealth services if the patient uses a particular company contracted with the payer to offer such services. Copayments may differ from in-person services.  Even patients with the same insurer may have different copays or coinsurance amounts than other patients covered by the same payer.  

The bottom line is that you and your patient communicate regarding any changes that may have been implemented by their insurer.  Submit your claims quickly, so that you can receive denials in a timely manner and address any issues.  This is a time of change, and benefit verification is essential.  If you are a customer of Health Assets, request a new verification of benefits whenever you have a doubt.  It is worth the peace of mind for you and your patient.

Like with everything else during this time of flux and uncertainty, calm minds and compassion for each other will go a long way. Our staff is with you as you navigate these uncharted waters.

Carmel L Gold, LCSW
Health Assets Management, LLC