Tag Archives: health care plan

New Medicaid Rules Support Telemedicine


The Centers for Medicare & Medicaid Services have issued a decisive rule that collates the policies related to the responsibilities of the state Medicaid agency in practicing and supervising access to innovative methods of healthcare.

According to the rule, states are required to come up with an access-monitoring plan, so that proper access to particular health care services can be ensured. The rule further corroborates that the plan must comprise numerous points the states use to examine access to healthcare, including needs of patients, time, distance and accessibility of telemedicine.

The CMS has now made it mandatory for states to craft a complete access-monitoring plan by July 1, 2016. The rule clearly states that the plan must elaborate the method states will use to oversee adequate access of patients to a primary set of telemedicine services as a starting point. It also requires states to evaluate performance of these services after every three years. The plan would also be left open for public opinions and suggestions before submitting it for approval.

According to CMS, telemedicine is comparatively an affordable option for the provision of healthcare services that states must bring under Medicaid. It is worth mentioning here that the federal Medicaid statute does not deem telemedicine as a separate service.

So, after this rule is executed, patients would be able to access health care across state lines. This would not only improve healthcare services, but also provide patients easy access to highly talented specialists across state lines, and then get reimbursed for it. Likewise, physicians can get benefit of the plan by being reimbursed for remote patient services.

The Medicaid rule has made it obligatory for all service providers to operate telemedicine under the range of their State Practice Act. It is pertinent to note that some states require telemedicine service providers to get a license in the state where the patient is located before providing telemedicine services there.

In order to get reimbursed for Medicaid covered services, providers are also required to meet federal requirements of proficiency, affordability and excellence of healthcare. Moreover, states are supported to come up with groundbreaking payment gateways for telemedicine services. For instance, a state can reimburse the doctor or service provider at the remote location and reimburse the facility the patient used to access telemedicine.

States can also repay extra expenditures like the technical support and equipment used during the service in addition to the communication fees. These additional charges can be integrated into the service charges or billed and repaid as administrative fees. When they are billed and reimbursed independently, the cost would fall under the covered Medicaid services.

Can Telemedicine Improve Patient Experience and Boost Your Business?

Old retired woman sitting in front of monitor. She has just sent her blood pressure and pulse information to virtual doctor. At the same time, telemedicine physician is looking at her CT x-ray on the screen

Telemedicine is fast becoming a mainstream part of healthcare. Healthcare providers in the industry are using telehealth and telemedicine solutions. This is mostly due to the proven benefits of these solutions.

The entire cycle of healthcare is experiencing a change because of telemedicine. Telehealth systems have transformed homes, hospitals, care organizations, and behavioral health facilities. Hospitals are able to better support patients, employees and clients when they utilize telemedicine systems. But some organizations are still wondering if a telehealth system is worth the time and investment.

The American Telemedicine Association is a leading authority in the field, the CEO of the organization has stated the following opinion about telemedicine: ‘Some form of telemedicine has existed in primary care for a long time. What’s different is the change in technology and access to broadband that makes it more widely available to doctors and patients.”

Effect on patient care

Telemedicine is a win-win solution for both doctors and patients. These systems allow patients to directly communicate with doctors and relate all their medical issues with adequate face to face time. The doctor is trained to treat a virtual visit just as if it is an in-person visit. The level of care is maintained. Patients living in remote areas can also take advantage of this system and consult properly trained doctors. Patients can be empowered to monitor their health and keep up with their medicine regime through follow-up e-visits by nurses or consultants.
Hospitals often complain of a lack of integrated communication channels between them and their patients. Telehealth can help solve this issue by giving patients access to a single means of communication, record keeping, send emails alerts, or alerts on mobile devices to keep the patient’s informed.

Tech-savvy Patients and Telemedicine

Most patients are comfortable and familiar enough with technology to setup video conferencing and communicate with doctors from their home. This is a convenient option for many because patients can avoid travelling long distances and waiting in long lines at crowded clinics. A survey conducted by Telemedicine and e-Health, concluded that patients are “likely to be accepting of telehealth care to the home using video call and that most have the required technology.”

Benefits of Telemedicine

· Reduce healthcare costs
· Better patient outcomes
· Reductions in the number of readmissions
· Clients and patients are better satisfied with services
· Access to care is easy and quick
· Better communication between doctors and patients
· The outcomes and results are easily tracked
· Telemedicine systems are highly scalable

Negotiation Tips for Physicians


A value-driven healthcare system ensures that the doctors are adequately compensated for their services. The relative financial risks to physicians must be minimized if the payment model being utilized is to succeed. Most physicians either don’t know that the amounts reimbursed by your insurance plans can be negotiated or simply do not wish to engage in the negotiation battle and lengthy meetings that are implied. Negotiating is easier if the right approach is followed and will give the practice both short-term and long-term benefits.

Physicians and the Art of Negotiation

Negotiating a contract with a health plan is a complex, time-consuming, and frustrating task. Family physicians find themselves getting the short end of the stick. The contract being offered by default has been prepared by an army of financial, legal and administrative experts who will want to pay the lowest rates they can. Negotiating can be tricky and requires delving into piles of research. Physicians might not be natural negotiators; however the advantage here is that almost all physicians are experts at detailed analyses and research.
· Be patient and tenacious
· Be willing to walk away from unsatisfactory offers
· Accept the fact that there will be a lot of back-and-forth
· Build your business case
· Communicate it clearly

The Basic Process of Negotiating Health Care Plans

The first aspect that a physician needs to determine is what factors will improve their leverage during the negotiation. Having a clear idea of what you bring to the table can make the difference between having to settle for a low rate and getting the rate that you deserve.
Gesme and Wiseman offers the following general advice to increase reimbursement from private payers:
Self-Assessment and Preparation- SWOT and KPIs
The key to successful negotiation strategy is readiness. Do a thorough SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis of the practice. Look at all the factors objectively and critically. Check all your past data, measure the major key performance indicators (KPI’s) related to costs, quality and time. General practices normally have five areas that the KPIs are based on:
1) Financial performance
2) Patients
3) Employees
4) Medical data and patient services
5) Expenses
Comparative data is also required so check your position in quality assessment programs such as Physician Quality Reporting Initiative.

Monitor Your Present Contracts

Contracts are automatically renewed unless one party proposes a modification. Analyze your contract and decide exactly which changes you need. You should also know what percentage of your business is represented by the payer.

Good Negotiation Tactics-A Summary

● Present your requests for changes
● Ensure that the data you present is relevant, well-organized and clear.
● Listen to the other side and understand their goals
● Offer proof for any cost-minimizing measures you have implemented