Telemedicine Policy

Telemedicine has just got a boost with the American Medical Association (AMA) approving a list of the guiding principles presented at its Annual Meeting held from June 7-11, 2014. A component of telehealth, telemedicine generally refers to the provision of clinical services from a distance. The benefits include increased access to specialist consultations, improved access to primary and ambulatory care, and reduced waiting times.

AMA’s recognition will ensure appropriate coverage of reimbursement for telemedicine services on telemedicine. According to the nation’s largest association of physicians, appropriately used telemedicine can greatly improve access to care without compromising patient safety. The AMA says the evolution of telemedicine impacts all of its strategic focus areas:

  • Improving health outcomes
  • Enhancing physician satisfaction
  • Practice sustainability
  • Accelerating change in medical education

The House of Delegates, the principal policy-making body of the American Medical Association has voiced support for additional Medicare pilot programs to enable coverage of telemedicine services, including store-and-forward telemedicine, which involves transmitting medical data (such as medical images and biosignals) to a physician or medical specialist for assessment.

Before a telemedicine service is provided, AMA guidelines require the physician or other health professional to notify the patient of cost-sharing responsibilities and limitations in drugs that can be prescribed via telemedicine. The policy also encourages healthcare providers to verify that their medical liability insurance covers such services before they deliver any telemedicine services, including those provided across state lines.

AMA President Dr. Robert Wah said “We believe that a patient-physician relationship must be established to ensure proper diagnoses and appropriate follow-up care…this new policy establishes a foundation for physicians to utilize telemedicine to help maintain an ongoing relationship with their patients, and as a means to enhance follow-up care, better coordinate care, and manage chronic conditions.”

Telemedicine will improve access for patients to receive health care services remotely as medically appropriate including care for chronic conditions, which is a proven way to improve health outcomes and reduce health care costs. AMA stresses that the same standard of care must be maintained whether the physician is seeing the patient in person or via telemedicine.

The association will also work with the Centers for Medicare and Medicaid Services and other payers to develop and test payment models, and evaluate the effect of various telemedicine technologies on cost, quality, and the patient–physician relationship.

Each year, Medicare pays about $6 million for telemedicine services. Not all costs are reimbursed. Claims for professional telemedicine services should be submitted using the appropriate CPT code or HCPCS code, and the modifier “GT” or “GQ”. Due to the diverse reimbursement rules, hospitals, healthcare organizations, and healthcare systems should be knowledgeable about federal and state reimbursement laws and restrictions that govern medical billing for telemedicine services.