Population Health Insights

What's the Future of RPM/Telehealth Medicare Reimbursement?


When it comes to telehealth and remote patient management (RPM), one of the most pressing concerns for both patients and healthcare providers is a simple one: What’s the future of Medicaid/Medicare reimbursement?

Unfortunately, there isn’t a one-size-fits-all response to this question. Time and again, RPM has been shown to lower costs and improve care in numerous healthcare scenarios, thus offering much-needed relief to an industry facing historic challenges such as an increased number of insured patients along with a shortage of primary care practitioners.

Despite this, Medicaid/Medicare reimbursement for telehealth continues to be somewhat limited. As of September 2016, Medicare “only reimburses for live-video conferencing telehealth services under very specific circumstances,” notes the Center for Connected Health Policy (CCHP) in its telehealth reimbursement fact sheet.

“Additionally, current law places specific restrictions on the originating site (i.e. the physical location of the patient), practitioner at the distant site (i.e. the physical location of the practitioner) and types of services that can be delivered,” the CCHP adds.

So, for the most part, Medicare telehealth reimbursement doesn’t apply to transactions that occur across state lines. In an increasingly connected healthcare network, with technology connecting patients, providers and insurers from disparate locations across the country, this is becoming a bigger and bigger obstacle to implementing telehealth’s benefits on a nationwide scale.

Telehealth Medicare Reimbursement: Changes Underway?

But there’s good news: One by one, obstacles to widespread Medicare telehealth reimbursement are falling by the wayside.

Reimbursement is improving every month for remote patient management,” Care Innovations® Chief Operations Officer Marcus Grindstaff explains in a recent RPM Academy video. “There are some really great examples, like the state of Mississippi, where they've seen such a fantastic return on their investment from a Medicaid perspective, as well as great quality outcomes, that they've passed reimbursement and it's paid for by the state.”

Lessons from the UMMC Diabetes Network

“In addition, at the federal level, the Center for Medicare and Medicaid services is evaluating a nationwide reimbursement program,” Marcus adds, referring to 2016’s CONNECT for Health Act, a bipartisan bill designed to “expand and modify” the acceptance and reimbursement of telehealth and RPM services under Medicare.

Introduced into both the U.S. House and Senate last year, the CONNECT for Health Act (not to be confused with Connect for Health Colorado, that state’s health insurance marketplace) sought to waive a number of existing limitations against Medicare telehealth reimbursement and expand inclusions to include rural health clinic services and/or federally qualified health center (FQHC) services.

That federal bill may not have survived the 2017 legislative year, but the issue has hardly been forgotten. In recent months, many states have taken it upon themselves to enable Medicare telehealth reimbursement. For instance:

  • In Nebraska, lawmakers “have announced two separate bills that aim to make telehealth easier in the state” by requiring private payers to reimburse telehealth services at the same rate as in-person services, and by enlisting the state in the Federation of State Medical Boards’ Interstate Medical Licensure Compact, “which creates an expedited licensing process for providers wishing to practice across state lines.” (Via mHealthIntelligence.)
  • A Utah representative has introduced House Bill 154, which would “improve and expand telemedicine services in Utah” largely by “updating physician reimbursement models.” The bill has been passed by a committee and is now advancing to the state house floor. (Via Utah Public Radio.)
  • In Arkansas, legislation that would "expand the scope of telemedicine" with the inclusion of “all types of electronic information and communication technology” while also allow "health insurance to cover electronic consultations with physicians or other medical personnel who provide services comparable to in-person settings" was recently passed by a Senate committee. (Via KUAF.)

Representative of a larger movement to expand the positive effects of telehealth by dropping barriers to reimbursement, these bills are also not without controversy. For instance, the Utah bill has been criticized for including politically charged language that would “impact women’s constitutional right to safe and legal abortions,” per the UPR report.

And that, it can be argued, is another indication of the need for a federal, interstate set of Medicare telehealth reimbursement rules. Our experts say this change is coming. “We're really at the cusp of seeing that widespread option,” explains Consumer Experience Expert Karissa Price-Rico, PhD in the video.

It’s also important to note that, thanks to its help in shifting organizations to value-based care models, RPM will help lower costs even without reimbursements.

“Over the long haul, the shift to value-based care means that [telehealth] will become part of the standard care delivery,” Marcus says, “and in and of itself it doesn't need a specific reimbursement because it's reducing the total cost for the organization which is carrying the risk.”

VIDEO: Improving RPM Reimbursements

Got questions about telehealth Medicare reimbursement, or other aspects of remote patient management? We invite you to contact a Care Innovations representative for more information. And don’t forget to check out the Care Innovations RPM Academy for more videos highlighting the wide variety of benefits offered by remote patient management.

View More Telehealth Videos at the Care Innovations RPM Academy