According to the American Hospital Association (AHA), ”Limited Medicare coverage impedes the expansion of telehealth services. The current statute restricts telehealth services to patients located in rural areas and in specific settings, covers only a limited number of services, and allows only real-time, two-way video conference capabilities.”
In order for Telehealth to grow, the AHA says Medicare policy changes are needed. “Changes needed include: eliminating geographic and setting locations requirements so patients outside of rural areas can benefit from telehealth; expanding the types of technology that can be used, including remote monitoring; and covering all services that are safe to provide, rather than a small list of approved services.”
Medicare patients receiving Telehealth services must be located in the following areas:
- Outside of a metropolitan statistical area.
- In a rural Health Professional Shortage Area located in a rural census tract.
(A list of Health Professional Shortage Areas can be found here: (http://hpsafind.hrsa.gov). The U.S. Census maintains a list of Metropolitan Statistical Areas on its website (http://www.census.gov/population/metro/).
Private Payers
Private payers such as BCBS, UHC, Aetna, and Cigna have their own policies related to Telemedicine. Much of these policies will depend on the laws within the state the provider is located. Currently, there are 30 states required to cover Telemedicine. Payers in states that are not required to cover these services may choose whether they want to cover Telemedicine or not.
Knowing the different policies will be key to implementing this service in any practice. For example, in the state of Alabama BCBS will cover telemedicine, but only for certain types of visits. BCBS of AL will only cover services for cardiology conditions, dermatologic conditions, Infectious disease, behavioral health, or neurologic diseases (including stroke).
