Top 10 Tips: Telemedicine and Medicaid

Top 10 Tips: Telemedicine and Medicaid

Telemedicine is a great way to access medical services, as is discussed over at, with more and more people waking up to its benefits. For Medicaid patients looking to access telemedicine services, as well as providers looking to offer such services to their Medicaid patients, one of the questions that always crops up is the one pertaining reimbursements. This article, together with the gurus over at, should, therefore, be of great help as it will look to highlight the top 10 tips as pertains to telemedicine and Medicaid.

The state Medicaid programs that cover telemedicine

One of the most important things to know as far as telemedicine and Medicaid go, as per the gurus over at, are the state Medicaid programs that cover telemedicine. As it stands, as per discussions on the same over at, all state Medicaid programs, except for Massachusetts, Rhode Island, and Iowa, have got some coverage of telemedicine services.

Medicaid and live video interactions

As is discussed in detail over at, chances are that if your state’s Medicaid program has telemedicine, then the type of telemedicine they are likely to reimburse for is live videoconferencing, which, as per the gurus over at, is the most commonly covered form of telemedicine as far as Medicaid is concerned. It is important to note however that each state may restrict how they reimburse for video interactions based on the type of service provided, medical specialty type, the Originating Site as well as the Distant Site.

Medicaid and store-and-forward

When it comes to store-and-forward telemedicine services, only about 15 states reimburse for such services as far as Medicaid is concerned. Some of these states include Alaska, Georgia, Maryland, California, Nevada, Washington among others. On top of that, as is revealed in discussions over at, in these states, Medicaid programs also further restrict reimbursements based on factors such as services provided and the type of medical specialty.

Medicaid and remote patient monitoring

About 20 states, including Alabama, Illinois, Kansas, Louisiana, Maine, Nebraska, and the rest, covered over at, have some form of remote patient monitoring reimbursement in their Medicaid program. However, as is the case for videoconferencing and store-and-forward telemedicine, these state Medicaid programs have restrictions as far as the reimbursement qualifications are concerned.

Medicaid and facility fees

Facility fees, as discussed over at, refer to any costs incurred by the Distant Site when providing video or/and audio communication on the physician’s end. On top of that, we have what is referred to as transmissions fees which are the costs incurred by the Originating Site as they provide video and/or audio communication on the patient’s end. Currently, there are 32 states whose state Medicaid programs will reimburse for the facility fees, transmissions fees, or even both.

Medicaid and location restrictions

As discussed over at, Medicare restricts the geographical location of patients receiving telemedicine to those living in rural or underserving areas. On the other hand, state Medicaid programs usually only have limitations surrounding the type of facility at which a patient is receiving care. For instance, many Medicaid programs don’t reimburse for telemedicine care delivered to a patient in their home, among other such restrictions.

The role of informed consent

As far as Medicaid reimbursements are concerned, the role of informed consent cannot be overlooked. This is because, as per the gurus over at, about 31 states require that there be either a written or verbal consent from patients before a provider can provide care to them via telemedicine. You might, therefore, find that in most cases, in these jurisdictions, the same applies to their state Medicaid programs, where a patient has to give consent for treatment for the procedure to qualify for reimbursement.

Are there any other restrictions on Medicaid patients that are eligible for telemedicine?

In most states, any Medicaid beneficiary is eligible for telemedicine as long as the provider and patient are meeting all the set guidelines, such as doing the visit from an eligible Originating Site among others mentioned above, and covered over at There are generally not many other restrictions, although some states such as Idaho require Medicaid patients to be located in a rural area to be eligible for Medicaid reimbursement.

Billing for telemedicine as far as Medicaid is concerned

While, as is covered over at, billing guidelines vary from one state to another, in many cases state Medicaid programs follow the same procedure as those for Medicare. This means that you have to bill the appropriate CPT/HCPCS code, and then add on the GT modifier which indicates that the service was offered via telemedicine. While this is the general way of doing things, make sure you verify the billing guidelines with the Medicaid department in your state before you submit your claim.

Payment rates

Our next tip is aimed at the practitioners wondering how much they will get paid after they are reimbursed through Medicaid. As is revealed in discussions over at, in most cases Medicaid programs seem to be reimbursing for telemedicine services at pretty much the same rates they would for in-person services, which many practitioners out there would be happy to know.

The above discussions only begin to scratch the surface as far as this topic is concerned, and you can uncover more on this by visiting the highly rated