Telemedicine practices involves a new set of questions and answers insofar as physician payment and reimbursement for telehealth services. The laws that apply to traditional physician payment and reimbursement from insurance companies and U.S. government payers such as Medicare and Medicaid are not necessarily controlling law when it comes to telemedicine services. In some instances there are qualifications and requirements of physicians who use mobile health care in their practices and seek payment and reimbursement.
Telemedicine coverage by private insurance companies and direct-pay alternatives
While the majority of U.S. states passed laws defining telemedicine and the rights and duties with respect to insurance reimbursement. To date, however, there is no new law in Illinois requiring commercial insurance companies to cover charges for telemedicine, as they otherwise would be required to pay in a traditional doctor-patient service at the provider’s location.
Direct pay options may be appealing to some patients with relatively straightforward health care needs. When a doctor visit may only be necessary to refill a prescription, driving long distances and taking the day off from work can be burdensome. Certain patients may find the value in making direct payments to their doctors instead of submitting insurance or Medicare claims. Physicians offering services to patients on direct-payment plans might consider a separate fee schedule for cash-pay clients.
Illinois Medicaid defines telemedicine and telehealth and offers physician reimbursement
Physicians who include telemedicine in their medical practice may submit reimbursement claims with the State of Illinois. The Illinois Department of Healthcare and Family Services oversees the Illinois Medicaid program and they define telemedicine and telehealth services, for purpose of qualifying proper reimbursement claims.
The Illinois Statutes define telemedicine as follows: “”Telemedicine” means the performance of any of the activities…including but not limited to rendering written or oral opinions concerning diagnosis or treatment of a patient in Illinois by a person located outside the State of Illinois as a result of transmission of individual patient data by telephonic, electronic, or other means of communication from within this State.” The Illinois Medicaid program regulations further define telehealth, “as the use of a telecommunication system to provide medical services between places of lesser and greater medical capability and/or expertise, for the purpose of evaluation and treatment.”
The Department’s expansion of telehealth services also allows reimbursement and Medicaid coverage for advanced practice nurses, community mental health providers, encounter rate clinics (ERC), federally qualified health clinics (FQHC), hospitals, local education agencies, local health departments, physicians, podiatrists, and rural health clinics (RHC).
The Department defines telehealth policy requirements and restrictions with respect to the details of services, the originating site and the distant service sites. Encounter clinics are specifically addressed and as well the Expansion of Health Services announcement also provides examples of telehealth billing statements.
Michael V. Favia and Associates work with Illinois health care providers who practice telemedicine and offer telehealth services.
Chicago health law and litigation attorney Michael V. Favia and his associates in several locations and disciplines, advise and represent licensed physicians in all types of litigation and administrative matters involving licensing and regulatory agencies.
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