Telemedicine Reimbursement Through Medicare and Medicaid

Trying to understand Medicare and Medicaid's nuanced telemedicine reimbursement policy can often be confusing. Here is a detailed overview of the requirements for Medicare and Medicaid’s reimbursement policy:

Traditional Medicare (Part-B) and Medicare Advantage Plans (Part-C)

1

Are Medicare Part-B patients eligible for telemedicine?

Patients located at approved originating sites are eligible for telemedicine. Medicare defines an originating site as, “the location of an eligible Medicare beneficiary at the time the service furnished via a telecommunications system occurs.”  Medicare currently does not consider patients homes’ as approved originating sites, therefore causing the rules engine to determine Medicare Part-B patients ineligible.

Click the link below for a list of approved Medicare originating sites:

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf

2

Will Medicare Supplement plans cover telemedicine?

Providers must file all claims with the patient’s primary insurance prior to submitting the claim to the secondary insurance.

3

Do Medicare Advantage Plans (Medicare Part-C) cover telemedicine?

Yes, mandate states require Medicare Advantage Plans to cover telemedicine visits. Telemedicine state mandates, also known as a telemedicine parity laws, require private payers to provide coverage for telemedicine/telehealth services. Federal legislation does not currently exists, leaving it to the states to regulate.

Medicare Advantage Plans are required to comply with state mandates.

Medicare Chronic Care Management (CCM) with Telemedicine

1

Which patients are eligible?

All Medicare patients with two or more chronic conditions, and who are registered with the Medicare CCM Program are eligible.

2

What services qualify as Telemedicine CCM?

Your practice must first be registered with the Medicare CCM program in order to file these telemedicine claims through Medicare.

A clinical staff member must engage with the patient for 20 minutes or more in a calendar month. 30-day total time period between submitting claims for the same patient is required.

Medicaid

1

Are Medicaid patients eligible for telemedicine?

Medicaid programs in a number of states still follow the originating site rule. However, over 30 states offer some sort of telemedicine coverage. The Rules Engine determines which Medicaid patients are eligible or ineligible for video visits. 

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