Telemedicine and Medicare

Medicare is one of the two largest public health insurance programs available in the US. Medicare serves mostly the elderly (age >=65 years), but also provides health insurance to younger people suffering from severe disabilities.

Medicare – A Statistical Overview

Statista, a data specialist website that lists data from 18,000 different sources and is endorsed by journalists from The Wall Street Journal., lists the basic numbers for the Medicare program.
· Total number of Medicare hospitals in the US: 6,164
· Total Elderly Enrollment: 45 million
· The total Medicare spending: $600.3bn
· Share of Medicare in the total health expenditure by the US government: 20.1%
· Percentage of US citizens covered: 16% (44% of those are aged 65-74)
· Average percentage of cost covered by Medicare : 48%

Procedures Eligible For Telemedicine Reimbursement Under Medicare

According to the official patient information literature published by the Centers for Medicare and Medicaid Services. Medicare pays for some of the total Part B services provided by a physician or practitioner to a person who has Medicare coverage. These services must be provided via a telecommunications system. This tele-health system works as a substitute for an in-person visit.

Types of Health Workers Eligible For Telemedicine Practice and Billing

Medicare guidelines state that the following healthcare providers can practice telemedicine:
1. Physicians
2. Nurse Practitioners
3. Physician Assistants
4. Nurse Midwives
5. Clinical nurse specialists
6. Clinical Psychologists
7. Certified registered nurse anesthetists
8. Clinical Social Workers
9. Registered dietitians or nutrition professionals

Type of Telemedicine Covered by Medicare

Medicare only reimburses live telemedicine that is a real- time video conference between a doctor and a patient. The aim is to model a live session as closely as possible. However, the states of Hawaii and Alaska Medicare also allow reimbursement for store-and-forward telemedicine services.
Types of remote facilities covered by Medicare
Medicare covers the cost if the patient is rendered telemedicine services at one of the following location types:
1. Doctor’s office
2. Hospital or Critical access hospital (CAH)
3. Rural health clinics
4. Health center (only federally qualified ones)
5. A hospital-based or critical access hospital-based dialysis facility
6. Skilled nursing facility
7. Community mental health center

The Correct Telemedicine Billing Procedure According to Medicare

Use the proper procedure codes in your billing. Refer to the list of procedure and their CPT/HCPCS, found at the CMS website. The “GT” modifier must be appended to the codes to indicate that the procedure was conducted virtually. The asynchronous services has a special modifier, “GQ”,

Telemedicine Reimbursement Rates

The reimbursement rates of services provided via telemedicine systems are the same as those provided for real life visits.

For further information and details, you can consult these online resources:
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.html
https://www.cms.gov/Medicare/Medicare-General-Information/MedicareGenInfo/index.html
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/index.html?redirect=/telehealth/