Telemedicine

Ask the Experts: Telemedicine Payments

February 16, 2017 3:19 pm

We are a system with five hospitals across the country and would like to start using specialists at one site to offer consults via telemedicine to patients in other states. We worked out the legal and operational aspects of offering these services but are running into obstacles with health plans. We are being told that to offer telemedicine consults we need to use MDLive.com, which is not what we would like to do.

Are you offering and billing for telemedicine consults, and are you able to bill for the services when using providers across your system?

Answer: The health plans’ concerns are probably more related to insurance contracting than anything else. In other words, the MDLive.com requirement may be a limitation to individual patient insurance plans rather than the hospital’s issue. That said, the hospital could still provide telemedicine services through a different platform, but depending on its patient health plan profile, patients’ insurance may not cover the visits, making them, in essence, self pay for these services.

It is also important for hospitals to review health plan contract arrangements. If hospitals have restrictive health plan agreements that limit telemedicine platforms, then they likely should adhere to those limits so they can submit those claims to the insurance provider. Otherwise, those claims could be a breach of their standing agreement with the insurance company.

This question was answered by: Curtis H. Bernstein, CHFP, CPA/ABV, ASA, CVA, principal, Pinnacle Healthcare Consulting, and a member of HFMA’s Colorado Chapter.


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The information provided through the Forum’s Ask the Expert service does not constitute legal advice, even when the advice is provided by lawyers. You need to obtain your own legal counsel for legal advice, and consider the laws and regulations that govern your state. The content and opinions expressed are those of the Forum experts, and not that of their employers or of HFMA. HFMA does not endorse the material or warrant or guarantee its accuracy. The responses are based only on the specific facts or circumstances provided. Forum experts cannot be held liable for outcomes related to any information provided.

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