Telehealth: Beyond Traditional Health Care

Thoughtware Article Published: Sep 12, 2018
Nurse holding ipad with icons flying over it

Telehealth services enhance the ability to provide quality, low-cost medical care to patients via communication avenues such as text messaging, face-to-face video and telephone.

According to the Employee Benefit Adviser, nearly “60% of employers with over 500 employees provide for coverage in their medical plans.” Telehealth is an instrumental piece in the advancement of health care services. According to a report by Grand View Research, Inc., “the market is expected to reach 2.8 billion by 2022.”

Governmental and commercial payors are increasingly allowing for coverage of this modernized delivery model. However, before providing telehealth services, it’s important to understand all payor guidelines and reimbursement, since they can differ between plans and requirements can vary from state to state.

The Centers for Medicare & Medicaid Services (CMS) expanded coverage and reimbursement (by Medicare Administrative Contractor (MAC))* in 2018 with the following code sets:




Comprehensive Assessment &/or Care Planning for Patients Requiring Chronic Care Management


Psychiatric Treatment–Interactive Complexity

96160 & 96161

Health Risk Assessment

90839 & 90840

Psychotherapy for Crisis


Remote Patient Monitoring

*Contact your local MAC for the fee schedule.

The American Medical Association (AMA), a strong advocate for and leader in telehealth, said in an immediate release on June 13, 2016, “The new AMA ethical guidance notes that while new technologies and new models of care will continue to emerge, physicians’ fundamental ethical responsibilities do not change.”

A strategic approach to keeping abreast on regulations and reimbursement is significant when adopting telehealth services, as providers and health care facilities must establish their own policies and procedures in addition to updating compliance plans. Careful attention to documentation, billing and coding policies is crucial to help keep an organization’s telehealth program effective and away from compliance issues. Thus, it’s imperative to pay specific attention to CMS guidelines such as the following:

  • Qualifications of an “originating site”

  • Providers considered eligible for reimbursement

  • Appropriate devices for communication with the distant site

  • Proper coding and documentation guidelines

  • How to develop policies and procedures for services

  • MAC’s fee schedule

  • Ongoing changes and how they may affect the organization

Health care providers must be committed to providing quality and affordable patient care through cutting-edge technology, especially to those who may not have access.

BKD’s Health Care Performance Advisory Services team has the expertise to help facilitate enhancements of your revenue cycle through telehealth services. For more information, complete the form below or explore our suite of health care resources.

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