Healthcare is, understandably, undergoing a few growing pains. With 2020’s pandemic exponentially blowing up the importance and necessity of telehealth, several providers scrambled to quickly adopt new tech such as portable medical computer systems and services like remote patient monitoring before other logistics behind telehealth adoption were fleshed out. Because of this rapid restructuring, telehealth reimbursement still remains a confusing topic as of late. We know the recent successes in telehealth adoption will increase demand for it in the post-COVID future but, we still aren’t quite sure which telehealth services will remain supported after we exit this stage of emergency. Thus, there’s confusion in both how reimbursement for telehealth is being handled today and how it will be handled tomorrow.   

This puts facilities in a rather precarious predicament. They know further investment in telehealth applications will be essential and want to begin expanding their remote care options, but they aren’t sure just how far they should delve into these investments because details regarding what they’ll actually be reimbursed for still remain up in the air.

Fortunately, there are ways to plan ahead even when dealing with the notorious ambiguity behind telehealth reimbursement. And as is common in most exercises in foresight, paying attention to what we can observe today will always provide some valuable reference data. 

How is Telehealth Reimbursed?

Unfortunately, the question of “how is telehealth reimbursed” can hardly be answered in simple terms. As we mentioned, adoption of these new remote services were so hurried and unexpected that proper programs and policies behind telehealth reimbursement rates weren’t entirely worked out.

Of course, telehealth reimbursement and telehealth reimbursement rates vary depending on your particular state’s reimbursement policies. Some states mandate that remote visits and services be reimbursed at the same rates as face-to-face equivalents of those services. It’s also important to note that the kinds of services that are reimbursed at all also vary from state to state. Unfortunate as it is for simplicity, not all telehealth treatments and costs are blanketed together as one billable service. What’s considered “telehealth” can vary from program to program. According to medicaid’s site, for example, telehealth reimbursement includes any additional costs that are intrinsic to remote care such as tech support and transmission charges. Depending on the different payment programs available, what’s actually covered by reimbursement can vary.

In short, reimbursement for telehealth is… confusing. It’s not a one-size-fits-all approach in the slightest which means meticulous research needs to be done on how your state and payment programs handle reimbursement and what services they support. 

Despite this excessively flexible approach to defining and reimbursing telehealth, there are a few best practices any facility can follow that will make the reimbursement process easier to navigate. Furthermore, following these practices can also help you prepare for future telehealth support policies as they become known, allowing you to more accurately predict what services will be available and worth investing in.   

Clinical Documentation Will be Essential

If there’s one thing this ambiguity in telehealth reimbursement can teach us, it’s that documentation of services administered is going to be essential in the coming years (as if it wasn’t already).

Knowing ahead of time what your state requires as far as documentation can help you re-format note-taking policies and implement clinical documentation improvement practices to better meet these requirements and receive payment. Soap method medical notes are another powerful tool that can make the note taking process more streamlined and easier to navigate for those who will be preparing documentation in order to receive reimbursement for telehealth services rendered. Regardless of the note-taking procedure you end up using, the more clear, concise, and focused on what you know your state needs to reimburse you for remote care your notes are, the better. 

To that end, using healthcare computers that make logging this information and logging into EHRs easy with tools such as RFID scanning and other peripherals can help cut down on human error and incorrect documentation that can stall reimbursement.

Telehealth Software

Proper telehealth software can also help in regards to this need for proper documentation. Beyond that, however, it can also help avoid frustration that can cause staff to avoid seeking reimbursement altogether. 

In a recent interview, healthcare lawyer Andrew Selesnick commented that he often observed that clinicians would willingly not bill for services because the amount of hoops they needed to jump through to gather data after a remote visit and prep it for telehealth reimbursement was simply too much. Like we mentioned, clinical documentation improvement policies can help make documenting this data easier, but without proper telehealth software designed to make remote care documentation easier, it’ll remain an uphill battle.

Take a piece of software like Chiron’s, for example. The program houses a database of the most up to date telemedicine insurance rules and guarantees full private payer reimbursement for telehealth visits. By observing what services are administered during a remote visit and referencing that with its database of policies, it can help format documentation for reimbursement and even calculate accurate payment determinations. 

Of course, Chiron’s isn’t the only software of its kind out there. There are many solutions like there’s that can help cut down on burned out physicians as well as missed opportunities for payment. 

Stay Up to Date on Telehealth Reimbursement Rates and Policies

Taking a page from Chiron’s book, learning to stay on top of your state’s ever-changing policies on reimbursement for telehealth will remain best practice for now. Like Selesnick mentions in his interview, “we’ve probably had more regulatory reform in the last 6 months than we’ve had in the last 6 years when it comes to telehealth.” 

The list of services that are eligible for telehealth reimbursement are in a state of constant flux right now as the world plays healthcare by ear based on how COVID, vaccines, and elections pan out. The more information you have on what kinds of services are offered right now, how often they’re being used, and whether or not your state is reimbursing for both telehealth AND telemedicine (because there is a difference), the better informed you’ll be in supporting internal telehealth programs that will still be reimbursed in the future.

Plan for Some Scaling Back of Telehealth Reimbursement

Providers need to be careful not to assume every telehealth application that’s supported now will be supported post-COVID. As mentioned, everyone is still experimenting with what telehealth services are needed, which are needed only right now, and which will be needed indefinitely as we see more success in their implementation. Planning for telehealth intelligently will be tempered with expectations of certain services being dropped and no longer reimbursed as well as some being maintained. Depending on your own patient populations, state policies, and experiences, you can better make these predictions and prepare for the future you think is most likely to occur.

Making Educated Predictions

Unfortunately, planning for future telehealth requires a lot of guessing and predicting. And while there’s no guarantees in what telehealth services will still be supported for reimbursement, there are several steps you and your staff can take in order to ensure any investments made towards future remote care are educated, well-informed, and made with the best intentions towards your valued patients. For more information on how you can prepare for future telehealth applications, contact an expert from Cybernet today.