The document summarizes telehealth reimbursement policies across different payers including Medicaid, Medicare, and private insurers. It provides statistics on how many states reimburse for different telehealth services through Medicaid and cover telehealth for state employees. The document also discusses Medicare reimbursement guidelines and initiatives to expand coverage. Additional sections cover the Medicare Quality Payment Program and various payment models being tested through the CMS Innovation Center. Private insurance telehealth policies and potential telehealth revenue models are also addressed.

1. Presented By:
Heather Zumpano
heather@telehealthsuppliers.com
@HZumpano
Aneel Irfan
aneel@telehealthsuppliers.com
@Aneel_Irfan

2. Medicaid
Medicare & MACRA
Quality Payment
Program
Private Insurance
Revenue Models

3. 48 states reimburse for live video 2-way communication
19 states reimburse for remote patient monitoring
12 states reimburse for store and forward
30 states reimburse for a transmission/facility fee
2 states reimburse through the Dept. of Aging Services
For your state’s specific Medicaid Reimbursement Laws, visit the Center for
Connected Health Policy website: cchpca.org
Reimbursement By the Numbers:
29 states require signed informed consent prior to visit

4. 24 states cover telehealth for state employees
24 states plus D.C. cover care regardless of origin
25 states recognize home as originating site
41 states cover service state-wide
28 states don’t require a telepresenter
Reimbursement By the Numbers:
15 states plus D.C. will pay any type of provider
For your state’s specific Medicaid Reimbursement Laws, visit the Center
for Connected Health Policy website: cchpca.org

5. Guidelines based on traditional care models and limited to
Health Professional Shortage Areas and specific care
centers (i.e. CAH, FQHC, SNF, CMHC)
Legislation is making its way through Congress to expand
Medicare coverage

6. Use the correct CPT/HCPCS code
2. Add the “GT” modifier to show the visit was
virtual
3. The originating site uses HCPCS code Q3104 to
bill a transmission/facility fee
2017 List of Services and CPT Codes

7. 1. Advanced Alternative Payment Models (APM)-
Earn an incentive payment for participating in an
innovative payment model
2. Merit-based Incentive Payment System (MIPS)-
Earn a performance-based payment adjustment
To qualify, you must bill Medicare more than $30,000 in Part B charges and
provide care for more than 100 Medicare patients a year.
Visit https://qpp.cms.gov

8. 1. Accountable Care
2. Episode-Based Payment Initiatives
3. Primary Care Transformation
4. Initiatives Focused on Medicaid and CHIP
Populations
Source: https://innovation.cms.gov/initiatives/#views=models

9. 5. Initiatives Focused on Medicaid/Medicare
Enrollees
6. Initiatives to Accelerate Development and
Testing of New Payment/Service Delivery
Models
7. Initiatives to Speed Adoption of Best Practices
Source: https://innovation.cms.gov/initiatives/#views=models

10. Combination of Meaningful Use, PQRS, and the Value-Based
Modifier into one performance based payment program
Allows providers to select their measures, track the data
and report to CMS
Physicians are reimbursed per member per month or
billed on a per case rate

11. CMS encourages participation in the APM and MIP
programs as research methodologies to identify the
future of health care payment reform
If you have an idea for a payment model for either
payment track, CMS wants to hear from you. Each year
they post their provisions for open discussion and
incorporate ideas into the Final Rule.
Be the Change You Want to See!

12. Source: http://www.americantelemed.org/main/policy-page/state-policy-resource-center
34 states and DC have a Telemedicine Parity Law

13. Aetna
Anthem
Blue Cross/Blue Shield
Cigna
United Health Care

14. Institution to Institution- Payment models
include a monthly contract, hybrid payment, or fee
schedule menu of services and specialties.
Employer Workforce- Physicians can offer
employers a primary care network using on-site kiosks,
mobile apps, or computers to bring medical access to their
employees. Services can be paid by an employer’s self-
funded health plan, out-of-pocket by an employee, per
member per month, or case rate.

15. Direct-to-Consumer- Patients can pay out-of pocket
or use their HSAs monthly or annually for access to these
services. In many cases the virtual visit is about the same
rate as a co-pay for an in-person visit.
International Agreements- the large demand for
U.S. doctors in other countries presents great
opportunities to contract with foreign governments, NGAs,
and medical practices. There are also less legal barriers
to providing care in the global medical arena.

16. Thank You for Attending!
Heather Zumpano
heather@telehealthsuppliers.com
@HZumpano
Aneel Irfan
aneel@telehealthsuppliers.com
@Aneel_Irfan