We are a system with five hospitals across the country and would like to start using specialists at one site to offer consults via telemedicine to patients in other states. We worked out the legal and operational aspects of offering these services but are running into obstacles with health plans. We are being told that to offer telemedicine consults we need to use MDLive.com, which is not what we would like to do.
Are you offering and billing for telemedicine consults, and are you able to bill for the services when using providers across your system?
Answer: The health plans’ concerns are probably more related to insurance contracting than anything else. In other words, the MDLive.com requirement may be a limitation to individual patient insurance plans rather than the hospital’s issue. That said, the hospital could still provide telemedicine services through a different platform, but depending on its patient health plan profile, patients’ insurance may not cover the visits, making them, in essence, self pay for these services.
It is also important for hospitals to review health plan contract arrangements. If hospitals have restrictive health plan agreements that limit telemedicine platforms, then they likely should adhere to those limits so they can submit those claims to the insurance provider. Otherwise, those claims could be a breach of their standing agreement with the insurance company.
This question was answered by: Curtis H. Bernstein, CHFP, CPA/ABV, ASA, CVA, principal, Pinnacle Healthcare Consulting, and a member of HFMA’s Colorado Chapter.
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