How-to Series

Unraveling the Mystery of Telemedicine

Reimbursement

Webinar Agenda

Intro Medicare Reimbursement Private Payer Reimbursement Case Studies in Complexity How to be Reimbursed Demo Q&A

Why do we care about telemedicine reimbursement?

Replace unpaid phone calls with billable telemedicine encounters

Lab results Medication adjustments

Increase practice efficiency See more patients without increasing overhead

Reimbursement remains one of the final barriers to widespread adoption of telemedicine. Here’s why it matters:

1

2

What makes reimbursement so complex?

1. State regulations Is there a reimbursement mandate? What exceptions or restrictions are in place?

2. Payer nuance CMS Restrictions Different payers treat telemedicine differently

3. CPT Codes What codes to use?

Medicare Reimbursement

1. Patient location restricted Qualified healthcare facility (originating site fee) Rural area (resource)

2. Provider must be present at distant site Distant provider bills visit, provider at originating site bills facility

fee

3. What codes? Office visit + GT (ex 99202 GT) 99490 – Medicare CCM HCPS code Q3014

Private Payer Reimbursement 30 states require coverage – parity law Many plans cover telemedicine regardless of parity

law Common CPT Codes: 99201 - 99215

Some require GT modifier, others do not The only way to know is to call the payer and check a

patient’s plan…

What to look for in your state’s mandate Is the originating site restricted? (like CMS) When does the law go into effect? Other exceptions

Plan exceptions Patient relationship Type of services covered?

Case Study #1

Private payer reimbursement for telemedicine mandated in Texas

Some small employer and disease-specific health plans exempt

Texas Insurance CodeChapter 1455. Telemedicine and Telehealth

Sec. 1455.004. Coverage for telemedicine medical services and telehealth services.

(a) A health benefit plan may not exclude a telemedicine medical service or a telehealth service from coverage under the plan solely because the service is not provided through a face-to-face consultation.

Chiron Reimbursement Guarantee®

Prior patient relationship required (must have been seen in person in last 12 months)

Prior relationship restriction injunction in place as of May 2015

Texas

Private payer reimbursement for telemedicine mandated in Arizona

Originating site must be located in a rural county: Population less than 900,000 or Greater than 900,000 but more than 30 miles

from a county with population of 500,000 or more

AZ Statute, Sec. 20-841-.09Telemedicine; coverage of healthcare services

A. All contracts issued, delivered or renewed on or after January 1, 2015 must provide coverage for health care services that are provided through telemedicine if the health care service would be covered were it provided through in-person consultation between the subscriber and a health care provider and provided to a subscriber receiving the service in a rural region of this state.

Limits types of service to: Trauma, burn, cardiology, infectious

disease, mental health disorders, neurologic diseases including stroke, dermatology

Case Study #2 Arizona

Our Story

Andrew O’Hara – Founder and CEO

Founded in 2013 by two grad students at the University of Texas at Austin

Mission: To help physician practices provide convenient access to their patients through secure video visits — and receive full reimbursement.

Built with love in

Video-based telemedicine is quickly becoming the standard for many types of office visits – Chiron Health provides the tools and support to make this a no-brainer for physician practices.

“

”

Why Chiron Health?

1. Chiron Reimbursement Guarantee®

Full private payer reimbursement, guaranteed. Insurance eligibility rules engine

2. Seamless integration into your EHR Schedule video visits exactly like in-person visits We verify your patients’ insurance and check them in virtually

3. World-class customer support We have only one job: To ensure you and your patients have a

phenomenal telemedicine experience

Questions?Request a demo to see how you can offer convenient video visits in your practice.

Visit: www.chironhealth.com