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How to Create Your Telemedicine Billing Policy

One of the key parts of ensuring your new telemedicine solution brings your practice an ROI is setting up the right telemedicine billing strategy.

How much will you charge your patients for a telemedicine visit? Will the fee vary based on the service? Will you go the reimbursement or cash-pay route for telemedicine?

These are a few of the key questions you’ll need to answer to create your telehealth billing policy.

So how do you decide what the right answers are for your practice? Here is some key information to help guide you.

The Concierge or Self-Pay Model

If you’re a concierge or direct-pay practice, setting up your telemedicine billing policy is straightforward. Decide on your telemedicine use case (what kinds of health services or appointments will you be providing? What patient populations will you be targeting?) and then think about pricing.

Will you charge the same rate as for the comparable in-person service? Will you charge more for the added convenience? Will you charge nothing and just offer telemedicine as an added service to your concierge subscription fee?

Decide what would work best for your practice and patient population. We have providers charging a wide range of fees, from $35 for a 15-minute urgent care visit, to $400 an hour for a specialist or mental health consultation.

Are you a practice with a traditional reimbursement model who wants to offer telemedicine on a cash-pay basis? No problem. Just have your patients sign a waiver saying they won’t be using their insurance for telemedicine visits, and then set your fee. We’ve found many patients are willing to pay a little extra for the convenience of telemedicine, especially if it save them a long trip to the office or a visit to the ER.

Research the reimbursement guidelines for payers in your state, and write them into your billing policy.

Navigating the telemedicine reimbursement landscape can be a little tricky. Fortunately, there are some great tools that can help you.

How reimbursement for telemedicine works depends in large part on which type of payer you’re talking about. Medicare, Medicaid, and private payers all work a little differently, and can vary state-to-state.

If you’d like to explore reimbursement through Medicare, check out our page all about Medicare & Telemedicine Reimbursement, and this helpful PDF from the Medicare learning network. You’ll find all the basic guidelines and billing codes you’ll need to set-up a Medicare eligible telemedicine program.

Note that these guidelines only apply for traditional Medicare. Medicare Advantage plans actually have much more flexibility when it comes to telemedicine, and follow the private payer guidelines.

If you’re looking into Medicaid, check out the Medicaid guidelines for your state. It’s also always a good idea to contact your Medicaid rep for the latest telemedicine guidelines. You’ll notice Medicaid often has similar types of requirements and billing policies as Medicare, but may be more flexible and cover a wider range of providers and health services.

So, what about private payers? We’ve called around and found most of the Big Five health insurance companies (United Healthcare, BCBS, Aetna, Humana, Cigna) offer coverage for telemedicine. Plus, if your state has a telehealth parity law, state policy requires private payers in your state to reimburse telemedicine in the same way as comparable in-person services. It’s basically an added assurance that private payers will reimburse for telemedicine in your state.

Take these tips and explore telemedicine reimbursement for the payer type that’s most relevant for your practice. If you’d like a little more guidance, check out our full telemedicine reimbursement guide.

Ready to create your telemedicine billing policy? It might require a little work upfront, but it can bring a huge ROI and a boost in your patient outcomes in the long run!

We’d love to know–how do you approach billing for telemedicine?

Let us know in the comments!

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