What is payment parity?

Some payment parity mandates require payments to be “on the same basis” as in-person services, and others require payments “not less than” or even “not more than” those for in-person services. The effects of a payment parity mandate depend on its specific language.

What does the term payment parity mean?

The other type of parity, which is less common among states, is 'payment parity'. This is a requirement for the same payment rate or amount to be reimbursed via telehealth as would be if it had been delivered in-person.

Is telehealth reimbursed at a lower rate?

In a little more than 14 months, it has evolved from a niche offering that allowed patients to see clinicians while keeping socially distant to becoming a big part of the future of healthcare. Telehealth was a viable service before the pandemic, but it was reimbursed at lower rates than in-office visits.

Will telehealth continue to be reimbursed?

Even if states continue to require insurers to cover telehealth, a major variable is whether payers will be required — or choose— to reimburse telemedicine at the same level as in-person care. Currently, less than half of states mandate parity for remote care .

Does insurance cover remote patient monitoring?

Remote Patient Monitoring is most commonly paid for by patient insurance coverage and by government healthcare such as Medicare. For Medicare patients, practitioners bill Medicare to be reimbursed for Remote Patient Monitoring services. Practitioners can bill Medicare by submitting CPT codes for various services.

Exchange Rates

Who pays for remote patient monitoring?

Remote patient monitoring is covered by Medicare. As of July 2020, it's also covered by 23 state Medicaid programs, according to the Center for Connected Health Policy.

What is the copay for remote patient monitoring?

Is there a copayment associated with RPM services? For Medicare beneficiaries: Yes. RPM services, like other Medicare Part B services, are subject to a 20% beneficiary copay. This copay is generally not waivable, but it may be covered if a patient has supplemental coverage or Medicaid.

What is the difference between telehealth and telemedicine?

While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.

How is telemedicine billed?

When billing telehealth services, healthcare providers must bill the E&M code with place of service code 02 along with a GT or 95 modifier. Telehealth services not billed with 02 will be denied by the payer. This is true for Medicare or other insurance carriers.

Is telehealth reimbursed differently?

The bottom line is telehealth reimbursement can vary a lot depending on your state, practice, services, and the third-party payer.

What is payment parity telehealth?

Advocates for payment parity argue that telemedicine visits are costly to set up and consume the same amount of resources—or more—as in-person visits. Payment parity laws provide resources for providers to cover these costs.

Can a doctor charge for a phone call?

In some cases, doctors are billing for telephone calls that used to be free. Patients say doctors and insurers are charging them upfront for video appointments and phone calls — and not just copays but sometimes the entire cost of the visit, even if it's covered by insurance.

What is the POS for telehealth?

POS code 02 should continue to be used when telehealth is provided anywhere other than a patient's home (e.g., a hospital or skilled nursing facility).

What does full parity mean?

When a plan has parity, it means that if you are provided unlimited doctor visits for a chronic condition like diabetes then they must offer unlimited visits for a mental health condition such as depression or schizophrenia. However, parity doesn't mean that you will get good mental health coverage.

Which states have parity laws?

States with payment parity laws are Arkansas, California, Delaware, Georgia, Hawaii, Kentucky, Minnesota, Missouri, New Mexico, Texas, Utah, Vermont, Virginia, and Washington.

Does CMS reimburse for telemedicine?

CMS had expanded flexibility for providers to get Medicare reimbursement for telehealth at the onset of the COVID-19 pandemic. But the flexibility only lasts through the public health emergency, which was extended through early 2022.

What does modifier 95 stand for?

Per the AMA, modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” Modifier 95 is only for codes that are listed in Appendix P of the CPT manual.

Should I use GT or 95 modifier?

A GT modifier is an older coding modifier that serves a similar purpose as the 95 modifier. CMS recommends 95, different companies have varying standards for which codes to be billed. It is a good idea to check with the plans before billing.

What is the difference between 95 and GT modifier?

95 Modifier Modifier 95 is similar to GT in use cases, but, unlike GT, there are limits to the codes that it can be appended to. Modifier 95 was introduced in January 2017, and it is one of the newest additions to the telemedicine billing landscape.

What are the five examples of telehealth?

What equipment is used for telemedicine?

Telemedicine carts usually come equipped with computers, monitors, keyboards, cameras, and mobile medical devices, like digital scopes and wearable monitors. Hospitals are also increasingly using technology like interactive patient engagement systems to improve patient education and streamline workflows.

What is the difference between telehealth and telephone services?

Telemedicine is use of video conferencing, sending images for diagnosis and it is real time interactive services. Telephone visits are clinical exchanges that occur via telephone between the provider and the patient.

What is RPM and CCM?

Chronic care management (CCM) and remote patient monitoring (RPM) enables caregivers to pay close attention to patients. More importantly, it helps to take active measures to extend your care, and build a closer relationship with your patients.

Is remote patient monitoring considered telehealth?

2.4.

Remote patient monitoring (RPM) is a type of home telehealth that enables patient monitoring as well as transfer of patient health data to a health care provider.

What is RPM in medical billing?

On December 1, 2020, the Centers for Medicare and Medicaid Services (CMS) finalized new policies related to remote patient monitoring aka remote physiologic monitoring or “RPM,” reimbursed under the Medicare program.