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Telemedicine Reimbursement Rates

By Jonathan Terry, DO, ABIHM to Telemedicine


Telemedicine Reimbursement Rates

Our guest on Healthcare Matters is Jonathan Terry, DO, ABIHM. Dr. Terry is an osteopathic physician and surgeon and general psychiatrist who uses telemedicine extensively in his practice. Dr. Terry practices at the United Health Centers of San Joaquin Valley, which recently won the 2016 Health Delivery, Quality and Transformation Award from the American Telemedicine Association.In the seventh and final part of our series, Physician Focus: Telemedicine, we speak with Dr. Terry about physician reimbursement rates for telemedicine.

This is only one of many questions we asked Dr. Terry about telemedicine. Check them all out here:

  1. Defining Telemedicine
  2. Ways the Affordable Care Act Affects Telemedicine
  3. Four Advantages of Telemedicine
  4. Informed Consent and Telemedicine
  5. Electronic Medical Records and Documentation in Telemedicine
  6. Legislative Challenges to Telemedicine
  7. Telemedicine Reimbursement Rates
  8. Physician Focus: Telemedicine


Mike Matray: As our viewers understand, medicine is both a business and an art. How does the reimbursement rate, the business side vary from a telemedicine visit to a traditional doctor’s office visit?

Dr. Terry: You know Mike, I’m glad you asked that question. I think out of everything that we’ve talked about so far today, the reimbursement rate sort of remains one of the stickiest issues in telemedicine. It’s something that I do think is going to be worked out significantly in our professional careers, but it can vary a lot depending on the payer.

Medicare is especially interesting as it has so man limitations on facility location and eligibility, what services might be eligible for telemedicine, which providers can see a patient, and how claims are submitted. There’s actually a great summary of this, refer to the American Telemedicine Association on their website, just kind of outlining the Medicare laws. Interestingly state Medicaid programs in general have had far less restrictions, but of course this will vary state by state. Commercial insurers kind of opens up its own box of worms as each commercial payer might have its own set of limitations.

While I can’t necessarily speak in sort of broad conclusions about reimbursement, I will say that sort of each situation requires a bit of background research, starting with the patient, starting with the payer, but certainly for health groups that are located or work primarily with a certain team of third party payers. It would be easy to look at sort of say, your top five payers and see how do they incorporate telemedicine, and what’s accepted.

Mike Matray: Excellent. Well that was a fascinating discussion of telemedicine and both it’s history and what we can expect in the future. Thank you for your time, Dr. Terry.

Dr. Terry: My pleasure Mike. Thanks so much for having me on board.