http://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&feed=atom&action=historyTelemedicine reimbursement - Revision history2024-03-29T14:36:09ZRevision history for this page on the wikiMediaWiki 1.22.4http://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=20361&oldid=prevAnnathehybrid at 05:26, 18 February 20152015-02-18T05:26:15Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 05:26, 18 February 2015</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">The adoption of </del>[[telemedicine]] is <del class="diffchange diffchange-inline">hindered by </del>the <del class="diffchange diffchange-inline">lack of </del>reimbursement <del class="diffchange diffchange-inline">of a lot of services</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">When developing a business case for </ins>[[telemedicine]]<ins class="diffchange diffchange-inline">, it </ins>is <ins class="diffchange diffchange-inline">important that reimbursement rates are considered and alternative reimbursements streams are evaluated. In some cases, Medicare is reimbursing at 100% for all submitted claims, while in others </ins>the reimbursement <ins class="diffchange diffchange-inline">rate is closer to 40%</ins>. <ins class="diffchange diffchange-inline">Here are some telemedicine business models that have been proven to work: </ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Introduction ==</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>== Introduction ==</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">'''Reimbursement rates and percentages''' of cases that are being reimbursed for are not being tracked well. In some cases Medicare is reimbursing at a rate 100% for all submitted claims while in others the reimbursement rate is closer to 40%. When developing a business case for telemedicine, it is important that other reimbursements streams be evaluated. </del>Two terms that will be used frequently in this discussion is the Hub or Provider Site, and the Spoke or Patient Site. In many cases more then one model can be used at the same time. <del class="diffchange diffchange-inline"> </del>There are also some overlap between the different models. <del class="diffchange diffchange-inline">The goal of this article is to help organizations develop profitable and sustainable business models to support a hospital-to-hospital based clinical telemedicine program. Here are some telemedicine business models that have been proven to work: </del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>Two terms that will be used frequently in this discussion is the <ins class="diffchange diffchange-inline">'''</ins>Hub<ins class="diffchange diffchange-inline">''' </ins>or <ins class="diffchange diffchange-inline">'''</ins>Provider Site<ins class="diffchange diffchange-inline">'''</ins>, and the <ins class="diffchange diffchange-inline">'''</ins>Spoke<ins class="diffchange diffchange-inline">''' </ins>or <ins class="diffchange diffchange-inline">'''</ins>Patient Site<ins class="diffchange diffchange-inline">'''</ins>. In many cases more then one model can be used at the same time. There are also some overlap between the different models.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Third Party Insurance Reimbursement ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Third Party Insurance Reimbursement ===</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">Federal, State and Private Insurance Reimbursement. See list of CPT codes and State regulatory requirements below. Using the </del>reimbursement model the Spoke site is able to charge both a facility and technical fees associated with the patient visit<del class="diffchange diffchange-inline">. The type of private insurance company that reimburses for the telemedicine services vary from state to state, but all states are able to charge Medicare. In California for example all private insurance companies are mandated to reimburse for telemedicine services at the same rate as they do for in person services</del>. The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT. <del class="diffchange diffchange-inline">There are many nuances to Reimbursement and each facility will need to understand the requirements before they adopt it. For example, in </del>order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site. The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services. <del class="diffchange diffchange-inline">An example of this has been born out for Oncology services. In such a model</del>, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services. The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory. In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist. The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">In this </ins>reimbursement model<ins class="diffchange diffchange-inline">, </ins>the Spoke<ins class="diffchange diffchange-inline">/Patient </ins>site is able to charge both a facility and technical fees associated with the patient visit. The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* Caveat: In </ins>order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site. The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* Example: For oncology</ins>, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services. The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory. In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist. The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Per Click ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Per Click ===</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>This is a one-time fee paid by the Spoke/Patient site for each consult provided by a Specialist. A Hub/Consultant site should consider a 'per consult' or 'per-click' payment model if they have a large number of Medical Professionals who are already taking call every night for their existing facilities and have the extra manpower to provide additional services to locations who are understaffed. <del class="diffchange diffchange-inline">For example </del>a Hub might have several Intensivist working at a facility over a 24/7 basis who could meet a larger patient load. The Hub could contract for these Intensivists to be remotely on-call to cover ICU patient located at other facilities. Whenever a facility needs an ICU consult, they would call the Hub of Specialists and pay the Specialists for each consult that is provided to them.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>This is a one-time fee paid by the Spoke/Patient site for each consult provided by a Specialist. A Hub/Consultant site should consider a 'per consult' or 'per-click' payment model if they have a large number of Medical Professionals who are already taking call every night for their existing facilities and have the extra manpower to provide additional services to locations who are understaffed.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* Example: </ins>a Hub might have several Intensivist working at a facility over a 24/7 basis who could meet a larger patient load. The Hub could contract for these Intensivists to be remotely on-call to cover ICU patient located at other facilities. Whenever a facility needs an ICU consult, they would call the Hub of Specialists and pay the Specialists for each consult that is provided to them.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== On-Call / Shift Payment ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== On-Call / Shift Payment ===</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>A per shift fee is paid to one or Medical Specialists to be remotely on-call for a particular site. <del class="diffchange diffchange-inline">For example, </del>a Stroke Neurologist can be paid a fixed on-call fee for being available to provide a remote consult in the event that a patient presents to the Emergency Room with stroke symptoms. The Spoke site will pay the Stroke Neurologist a fixed fee for that shift and the Stroke Neurologist will provide as many consults that are required during that shift<del class="diffchange diffchange-inline">.  This model can be combined with a Reimbursement model, as at the same time both sites can bill for their services</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>A per shift fee is paid to one or Medical Specialists to be remotely on-call for a particular site.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* Example: </ins>a Stroke Neurologist can be paid a fixed on-call fee for being available to provide a remote consult in the event that a patient presents to the Emergency Room with stroke symptoms. The Spoke site will pay the Stroke Neurologist a fixed fee for that shift and the Stroke Neurologist will provide as many consults that are required during that shift.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Shared Resource Payment ===</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>=== Shared Resource Payment ===</div></td></tr>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>I am not aware of this model being used as of today but it certainly has potential. In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time. Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase. As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>I am not aware of this model being used as of today but it certainly has potential. In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time. Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase. As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">All work is original and provided by Yair Lurie</del></div></td><td colspan="2"> </td></tr>
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<tr><td colspan="2" class="diff-lineno">Line 77:</td>
<td colspan="2" class="diff-lineno">Line 84:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>This article attempts to outline both Federal, State and Private Insurance guidelines and policies.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>This article attempts to outline both Federal, State and Private Insurance guidelines and policies.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">=</del>==Federal Coverage<del class="diffchange diffchange-inline">=</del>==</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>==Federal Coverage==</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>CMS finalized their proposals to add the following requested services to the list of Medicare telehealth services for CY 2011:</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>CMS finalized their proposals to add the following requested services to the list of Medicare telehealth services for CY 2011:</div></td></tr>
<tr><td colspan="2" class="diff-lineno">Line 102:</td>
<td colspan="2" class="diff-lineno">Line 109:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In 2009, the Oregon State Legislature passed Senate Bill 24[1] to join the states specifying that insurance plans cannot discriminate against otherwise covered services that are provided by a telehealth method. Section 743A.058 of the Insurance Code of Oregon Revised Statutes reads as follows:</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>In 2009, the Oregon State Legislature passed Senate Bill 24[1] to join the states specifying that insurance plans cannot discriminate against otherwise covered services that are provided by a telehealth method. Section 743A.058 of the Insurance Code of Oregon Revised Statutes reads as follows:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>743A.058 Telemedical services. <del class="diffchange diffchange-inline">(1) As used in this section:</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>743A.058 Telemedical services.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">#As used in this section:</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (a) “Health benefit plan” has the meaning given that term in ORS 743.730.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (a) “Health benefit plan” has the meaning given that term in ORS 743.730.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (b) “Originating site” means the physical location of the patient receiving a telemedical health service.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (b) “Originating site” means the physical location of the patient receiving a telemedical health service.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (c) “Telemedical” means delivered through a two-way video communication that allows a health professional to interact with a patient who is at an originating site.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (c) “Telemedical” means delivered through a two-way video communication that allows a health professional to interact with a patient who is at an originating site.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"># </ins>A health benefit plan must provide coverage of a telemedical health service if:</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">(2) </del>A health benefit plan must provide coverage of a telemedical health service if:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (a) The plan provides coverage of the health service when provided in person by the health professional;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (a) The plan provides coverage of the health service when provided in person by the health professional;  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (b) The health service is medically necessary; and  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (b) The health service is medically necessary; and  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (c) The health service does not duplicate or supplant a health service that is available to the patient in person.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (c) The health service does not duplicate or supplant a health service that is available to the patient in person.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"># </ins>An originating site for a telemedical health service subject to subsection (2) of this section includes but is not limited to a:</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">(3) </del>An originating site for a telemedical health service subject to subsection (2) of this section includes but is not limited to a:</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (a) Hospital;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (a) Hospital;  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (b) Rural health clinic;  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (b) Rural health clinic;  </div></td></tr>
<tr><td colspan="2" class="diff-lineno">Line 124:</td>
<td colspan="2" class="diff-lineno">Line 128:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (g) Renal dialysis center; or  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (g) Renal dialysis center; or  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (h) Site where public health services are provided.  </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>* (h) Site where public health services are provided.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"># </ins>A plan may not distinguish between originating sites that are rural and urban in providing coverage under subsection (2) of this section.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">(4) </del>A plan may not distinguish between originating sites that are rural and urban in providing coverage under subsection (2) of this section.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"># </ins>A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service provided in person.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline"># </ins>This section does not require a health benefit plan to reimburse a provider for a health service that is not a covered benefit under the plan or to reimburse a health professional who is not a covered provider under the plan.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">(5) </del>A health benefit plan may subject coverage of a telemedical health service under subsection (2) of this section to all terms and conditions of the plan, including but not limited to deductible, copayment or coinsurance requirements that are applicable to coverage of a comparable health service provided in person.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">(6) </del>This section does not require a health benefit plan to reimburse a provider for a health service that is not a covered benefit under the plan or to reimburse a health professional who is not a covered provider under the plan.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">By Yair Lurie</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>[[Category:BMI512-WINTER-11]]</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>[[Category:BMI512-WINTER-11]]</div></td></tr>
</table>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=14124&oldid=prevAnnathehybrid at 15:06, 7 December 20112011-12-07T15:06:51Z<p></p>
<a href="http://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=14124&oldid=11645">Show changes</a>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=11645&oldid=prevAnnathehybrid at 23:01, 6 October 20112011-10-06T23:01:00Z<p></p>
<a href="http://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=11645&oldid=11644">Show changes</a>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=11644&oldid=prevAnnathehybrid: /* Oregon: */2011-10-06T22:59:27Z<p><span dir="auto"><span class="autocomment">Oregon:</span></span></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 22:59, 6 October 2011</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 88:</td>
<td colspan="2" class="diff-lineno">Line 88:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>743A.058 Telemedical services. (1) As used in this section:</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>743A.058 Telemedical services. (1) As used in this section:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(a) “Health benefit plan” has the meaning given that term in ORS 743.730.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(a) “Health benefit plan” has the meaning given that term in ORS 743.730.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(b) “Originating site” means the physical location of the patient receiving a telemedical health service.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(b) “Originating site” means the physical location of the patient receiving a telemedical health service.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(c) “Telemedical” means delivered through a two-way video communication that allows a health professional to interact with a patient who is at an originating site.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(c) “Telemedical” means delivered through a two-way video communication that allows a health professional to interact with a patient who is at an originating site.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>(2) A health benefit plan must provide coverage of a telemedical health service if:</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>(2) A health benefit plan must provide coverage of a telemedical health service if:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(a) The plan provides coverage of the health service when provided in person by the health professional;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(a) The plan provides coverage of the health service when provided in person by the health professional;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(b) The health service is medically necessary; and  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(b) The health service is medically necessary; and  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(c) The health service does not duplicate or supplant a health service that is available to the patient in person.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(c) The health service does not duplicate or supplant a health service that is available to the patient in person.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>(3) An originating site for a telemedical health service subject to subsection (2) of this section includes but is not limited to a:</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>(3) An originating site for a telemedical health service subject to subsection (2) of this section includes but is not limited to a:</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(a) Hospital;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(a) Hospital;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(b) Rural health clinic;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(b) Rural health clinic;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(c) Federally qualified health center;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(c) Federally qualified health center;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(d) Physician’s office;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(d) Physician’s office;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(e) Community mental health center;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(e) Community mental health center;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(f) Skilled nursing facility;  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(f) Skilled nursing facility;  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(g) Renal dialysis center; or  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(g) Renal dialysis center; or  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">    </del>(h) Site where public health services are provided.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">* </ins>(h) Site where public health services are provided.  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>(4) A plan may not distinguish between originating sites that are rural and urban in providing coverage under subsection (2) of this section.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>(4) A plan may not distinguish between originating sites that are rural and urban in providing coverage under subsection (2) of this section.</div></td></tr>
</table>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=11643&oldid=prevAnnathehybrid at 22:58, 6 October 20112011-10-06T22:58:35Z<p></p>
<a href="http://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=11643&oldid=11260">Show changes</a>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=11260&oldid=prevAnnathehybrid at 22:46, 15 September 20112011-09-15T22:46:33Z<p></p>
<table class='diff diff-contentalign-left'>
<col class='diff-marker' />
<col class='diff-content' />
<col class='diff-marker' />
<col class='diff-content' />
<tr style='vertical-align: top;'>
<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 22:46, 15 September 2011</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 1:</td>
<td colspan="2" class="diff-lineno">Line 1:</td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">'''</del>Telemedicine <del class="diffchange diffchange-inline">Service Business Models'''</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">[[</ins>Telemedicine<ins class="diffchange diffchange-inline">]] is now becoming widely recognized as both cost and clinically effective. Insurance reimbursement varies from state to state.</ins></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">== Headline text ==</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">== Telemedicine Service Business Models ==</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">Telemedicine is now becoming widely recognized as both cost and clinically effective. Insurance reimbursement varies from state to state. </del>One of the main factors hindering the widespread adoption of telemedicine is that much of the services are not being adequately reimbursed. Reimbursement rates and percentages of cases that are being reimbursed for are not being tracked well. In some cases Medicare is reimbursing at a rate 100% for all submitted claims while in others the reimbursement rate is closer to 40%. When developing a business case for telemedicine, it is important that other reimbursements streams be evaluated. Two terms that will be used frequently in this discussion is the Hub or Provider Site, and the Spoke or Patient Site. In many cases more then one model can be used at the same time.  There are also some overlap between the different models. The goal of this article is to help organizations develop profitable and sustainable business models to support a hospital-to-hospital based clinical telemedicine program.  Here are some telemedicine business models that have been proven to work:  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>One of the main factors hindering the widespread adoption of telemedicine is that much of the services are not being adequately reimbursed. Reimbursement rates and percentages of cases that are being reimbursed for are not being tracked well. In some cases Medicare is reimbursing at a rate 100% for all submitted claims while in others the reimbursement rate is closer to 40%. When developing a business case for telemedicine, it is important that other reimbursements streams be evaluated. Two terms that will be used frequently in this discussion is the Hub or Provider Site, and the Spoke or Patient Site. In many cases more then one model can be used at the same time.  There are also some overlap between the different models. The goal of this article is to help organizations develop profitable and sustainable business models to support a hospital-to-hospital based clinical telemedicine program.  Here are some telemedicine business models that have been proven to work:  </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''1. Third Party Insurance Reimbursement:''' Federal, State and Private Insurance Reimbursement. See list of CPT codes and State regulatory requirements below.  Using the reimbursement model the Spoke site is able to charge both a facility and technical fees associated with the patient visit.  The type of private insurance company that reimburses for the telemedicine services vary from state to state, but all states are able to charge Medicare.  In California for example all private insurance companies are mandated to reimburse for telemedicine services at the same rate as they do for in person services.  The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT.  There are many nuances to Reimbursement and each facility will need to understand the requirements before they adopt it.  For example, in order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site.  The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services.  An example of this has been born out for Oncology services.  In such a model, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services.  The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory.  In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist.  The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''1. Third Party Insurance Reimbursement:''' Federal, State and Private Insurance Reimbursement. See list of CPT codes and State regulatory requirements below.  Using the reimbursement model the Spoke site is able to charge both a facility and technical fees associated with the patient visit.  The type of private insurance company that reimburses for the telemedicine services vary from state to state, but all states are able to charge Medicare.  In California for example all private insurance companies are mandated to reimburse for telemedicine services at the same rate as they do for in person services.  The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT.  There are many nuances to Reimbursement and each facility will need to understand the requirements before they adopt it.  For example, in order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site.  The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services.  An example of this has been born out for Oncology services.  In such a model, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services.  The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory.  In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist.  The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.</div></td></tr>
</table>Annathehybridhttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=9660&oldid=prevYlurie at 09:38, 4 March 20112011-03-04T09:38:33Z<p></p>
<table class='diff diff-contentalign-left'>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 09:38, 4 March 2011</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''14. Group Purchasing Model''' – I am not aware of this model being used as of today but it certainly has potential.  In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time.  Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase.  As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''14. Group Purchasing Model''' – I am not aware of this model being used as of today but it certainly has potential.  In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time.  Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase.  As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins style="font-weight: bold; text-decoration: none;">All work is original and provided by Yair Lurie</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">The information that follows was copied in parts from sources provided by the American Telemedicine Association</ins></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div> </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>This article attempts to outline both Federal, State and Private Insurance guidelines and policies.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>This article attempts to outline both Federal, State and Private Insurance guidelines and policies.</div></td></tr>
</table>Yluriehttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=9659&oldid=prevYlurie at 09:37, 4 March 20112011-03-04T09:37:00Z<p></p>
<table class='diff diff-contentalign-left'>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 09:37, 4 March 2011</td>
</tr><tr><td colspan="2" class="diff-lineno">Line 6:</td>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''1. Third Party Insurance Reimbursement:''' Federal, State and Private Insurance Reimbursement. See list of CPT codes and State regulatory requirements below.  Using the reimbursement model the Spoke site is able to charge both a facility and technical fees associated with the patient visit.  The type of private insurance company that reimburses for the telemedicine services vary from state to state, but all states are able to charge Medicare.  In California for example all private insurance companies are mandated to reimburse for telemedicine services at the same rate as they do for in person services.  The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT.  There are many nuances to Reimbursement and each facility will need to understand the requirements before they adopt it.  For example, in order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site.  The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services.  An example of this has been born out for Oncology services.  In such a model, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services.  The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory.  In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist.  The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''1. Third Party Insurance Reimbursement:''' Federal, State and Private Insurance Reimbursement. See list of CPT codes and State regulatory requirements below.  Using the reimbursement model the Spoke site is able to charge both a facility and technical fees associated with the patient visit.  The type of private insurance company that reimburses for the telemedicine services vary from state to state, but all states are able to charge Medicare.  In California for example all private insurance companies are mandated to reimburse for telemedicine services at the same rate as they do for in person services.  The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT.  There are many nuances to Reimbursement and each facility will need to understand the requirements before they adopt it.  For example, in order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site.  The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services.  An example of this has been born out for Oncology services.  In such a model, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services.  The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory.  In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist.  The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">'''</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">2. Per Click:''' This is a one-time fee paid by the Spoke/Patient site for each consult provided by a Specialist.  A Hub/Consultant site should consider a 'per consult' or 'per-click' payment model if they have a large number of Medical Professionals who are already taking call every night for their existing facilities and have the extra manpower to provide additional services to locations who are understaffed.  For example a Hub might have several Intensivist working at a facility over a 24/7 basis who could meet a larger patient load.  The Hub could contract for these Intensivists to be remotely on-call to cover ICU patient located at other facilities.  Whenever a facility needs an ICU consult, they would call the Hub of Specialists and pay the Specialists for each consult that is provided to them.</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">'''</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">3. On-Call / Shift Payment.''' A per shift fee is paid to one or Medical Specialists to be remotely on-call for a particular site.  For example, a Stroke Neurologist can be paid a fixed on-call fee for being available to provide a remote consult in the event that a patient presents to the Emergency Room with stroke symptoms.  The Spoke site will pay the Stroke Neurologist a fixed fee for that shift and the Stroke Neurologist will provide as many consults that are required during that shift.  This model can be combined with a Reimbursement model, as at the same time both sites can bill for their services.</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">'''</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">4. Shared Resource Payment'''. In this model, the Spoke site and in some cases the Hub site share the costs of the telemedicine equipment.  Both sites form a partnership with a letter of understanding that the results of the telemedicine program will benefit both sites in-kind, and as such, no exchange of money is required.  For this model to work, a win-win situation must be created.  For both sites to win, they need to ensure the patient receives the best care possible.  This is a model that works well for a variety of patient populations such as stroke and neonatal care.  In the example of a stroke population, the Spoke site ‘wins’ if they can keep a larger proportion of stroke patients in their facility by having a remote consultant overseeing their care.  The Hub site ‘wins’ in that they can be sure that only the most needy patients are referred/transferred to them for care.  The patient transfer may result in interventions, operations and rehabilitation services.  The patient wins in that they get transported only when necessary and in either case will remain in the location that is best suited to care for their illness.  This has also been proven for Neonatal care.  In many cases Spoke sites are not equipped to handle high risk pregnancies and the complications that follow and if something goes wrong the baby needs to be transported to the closet neonatal ICU possible.  By having a remote Neonatologist involved with the high risk birth and delivery they can prepare the necessary resources to ensure that everyone is ready for the transfer of the baby and the mother will feel comforted that their baby is being well taken care of.  As the cost of the telemedicine equipment and services can sometimes be very expensive, a Hub in many cases elects to pay for all equipment for the first year or two.  This gives the Spoke site less risk and gives them time to prove the profitability of the partnership. In many cases it can take up to 6 months to get a clear ROI on telemedicine.  Care must be taken to ensure that Stark Law is not violated when using this model.</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''5. Grants''' - In this model, a Government or Privately funded grant is awarded and used to develop a telemedicine service line.  This model is useful to cover the upfront costs in starting a telemedicine partnership but can only serve as a bridge to the development and validation of a sustainable business model.  All grants should begin with a sustainable model in mind.  Too many grants have failed because a sustainable business model was not created.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''2. Per Click:''' This is a one-time fee paid by the Spoke/Patient site for each consult provided by a Specialist.  A Hub/Consultant site should consider a 'per consult' or 'per-click' payment model if they have a large number of Medical Professionals who are already taking call every night for their existing facilities and have the extra manpower to provide additional services to locations who are understaffed.  For example a Hub might have several Intensivist working at a facility over a 24/7 basis who could meet a larger patient load.  The Hub could contract for these Intensivists to be remotely on-call to cover ICU patient located at other facilities.  Whenever a facility needs an ICU consult, they would call the Hub of Specialists and pay the Specialists for each consult that is provided to them.</ins></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>6.  Subscription''' - In this model a Spoke site subscribes to one or more services from a Tertiary or Specialty care group/site.  They may for example subscribe for Infectious Disease, Intensivist Coverage, Hospitalist coverage, Cardiology services.  As such they will pay a monthly subscription fee for the service and as part of the subscription will be provided a certain number of consults during that month.  This can also be combined with the ‘per-click’ model.  An example of this model is a Critical Care service company that provides 24x7 Intensivist services.  The Spoke/Patient site pays a monthly ‘retaining or subscription fee’ and every time the Spoke site calls for a consult they also pay a one time consult fee so long as the consult is less then 1.5 hours long.  The Spoke sites have benefit from a strong ROI from this model as they can increase the number of ICU bed stays in the hospital which have a dramatic effect on their bottom line.  Another example of this model involves the use of PSOs – Professional Service Organizations – These are specialized and dedicated service organizations that provide a variety of telemedicine service lines.  Many PSOs today are providing Stroke, Hospitalist or Intensivist services. They may also contract with other independent specialists such as Psychiatrists, Nephrologists, and Infectious Disease Specialists to provide added value to their customers.  For a monthly fee you can contract with such an organization to provide specialized staff coverage for any of your departments.  Many of these companies work on a monthly subscription fee and may also tie in a per-click consult fee on top of that.  When contracting with such organizations all the Professionals providing consults must be licensed to practice in your state and in many cases must also have privileges in your hospital.  Such organizations may also bill insurance companies for their services.  In most cases the PSO services result in allowing the Spoke site to keep more patients within their facility and results in increased census.  This has become a very popular and profitable solution.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''3. On-Call / Shift Payment'''. A per shift fee is paid to one or Medical Specialists to be remotely on-call for a particular site.  For example, a Stroke Neurologist can be paid a fixed on-call fee for being available to provide a remote consult in the event that a patient presents to the Emergency Room with stroke symptoms.  The Spoke site will pay the Stroke Neurologist a fixed fee for that shift and the Stroke Neurologist will provide as many consults that are required during that shift.  This model can be combined with a Reimbursement model, as at the same time both sites can bill for their services.</ins></div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>7. Staff Efficiency''' – In this model there is no Hub site per se and generally no third party contracts.  A hospital purchases the telemedicine equipment to provide their existing staff with tools to better manage their patients.  For example, in one large academic medical institute, telemedicine is used by the Neurological Intensivist to round on patients at night while the Dcotor is at home.  Providing extra night-time rounds has resulted in a decrease in patient bed days and reduced complications of patients at night time allowing the Doctor to get more undisturbed sleep and night time pages.  Another example of this is allowing employed Hospitalist provide services remotely.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''4. Shared Resource Payment'''. In this model, the Spoke site and in some cases the Hub site share the costs of the telemedicine equipment.  Both sites form a partnership with a letter of understanding that the results of the telemedicine program will benefit both sites in-kind, and as such, no exchange of money is required.  For this model to work, a win-win situation must be created.  For both sites to win, they need to ensure the patient receives the best care possible.  This is a model that works well for a variety of patient populations such as stroke and neonatal care.  In the example of a stroke population, the Spoke site ‘wins’ if they can keep a larger proportion of stroke patients in their facility by having a remote consultant overseeing their care.  The Hub site ‘wins’ in that they can be sure that only the most needy patients are referred/transferred to them for care.  The patient transfer may result in interventions, operations and rehabilitation services.  The patient wins in that they get transported only when necessary and in either case will remain in the location that is best suited to care for their illness.  This has also been proven for Neonatal care.  In many cases Spoke sites are not equipped to handle high risk pregnancies and the complications that follow and if something goes wrong the baby needs to be transported to the closet neonatal ICU possible.  By having a remote Neonatologist involved with the high risk birth and delivery they can prepare the necessary resources to ensure that everyone is ready for the transfer of the baby and the mother will feel comforted that their baby is being well taken care of.  As the cost of the telemedicine equipment and services can sometimes be very expensive, a Hub in many cases elects to pay for all equipment for the first year or two.  This gives the Spoke site less risk and gives them time to prove the profitability of the partnership. In many cases it can take up to 6 months to get a clear ROI on telemedicine.  Care must be taken to ensure that Stark Law is not violated when using this model.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''5. Grants''' - In this model, a Government or Privately funded grant is awarded and used to develop a telemedicine service line.  This model is useful to cover the upfront costs in starting a telemedicine partnership but can only serve as a bridge to the development and validation of a sustainable business model.  All grants should begin with a sustainable model in mind.  Too many grants  </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>have failed because a sustainable business model was not created.  </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''6.  Subscription''' - In this model a Spoke site subscribes to one or more services from a Tertiary or Specialty care group/site.  They may for example subscribe for Infectious Disease, Intensivist Coverage, Hospitalist coverage, Cardiology services.  As such they will pay a monthly subscription fee for the service and as part of the subscription will be provided a certain number of consults during that month.  This can also be combined with the ‘per-click’ model.  An example of this model is a Critical Care service company that provides 24x7 Intensivist services.  The Spoke/Patient site pays a monthly ‘retaining or subscription fee’ and every time the Spoke site calls for a consult they also pay a one time consult fee so long as the consult is less then 1.5 hours long.  The Spoke sites have benefit from a strong ROI from this model as they can increase the number of ICU bed stays in the hospital which have a dramatic effect on their bottom line.  Another example of this model involves the use of PSOs – Professional Service Organizations – These are specialized and dedicated service organizations that provide a variety of telemedicine service lines.  Many PSOs today are providing Stroke, Hospitalist or Intensivist services. They may also contract with other independent specialists such as Psychiatrists, Nephrologists, and Infectious Disease Specialists to provide added value to their customers.  For a monthly fee you can contract with such an organization to provide specialized staff coverage for any of your departments.  Many of these companies work on a monthly subscription fee and may also tie in a per-click consult fee on top of that.  When contracting with such organizations all the Professionals providing consults must be licensed to practice in your state and in many cases must also have privileges in your hospital.  Such organizations may also bill insurance companies for their services.  In most cases the PSO services result in allowing the Spoke site to keep more patients within their facility and results in increased census.  This has become a very popular and profitable solution.</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''7. Staff Efficiency''' – In this model there is no Hub site per se and generally no third party contracts.  A hospital purchases the telemedicine equipment to provide their existing staff with tools to better manage their patients.  For example, in one large academic medical institute, telemedicine is used by the Neurological Intensivist to round on patients at night while the Dcotor is at home.  Providing extra night-time rounds has resulted in a decrease in patient bed days and reduced complications of patients at night time allowing the Doctor to get more undisturbed sleep and night time pages.  Another example of this is allowing employed Hospitalist provide services remotely.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''8. Outpatient Care Services''' – Medical Specialists agree to provide a variety of scheduled outpatient care services to facilities that lack the specialty.  For example, a Dermatologist has agreed to pay a critical access hospital a nominal fee per patient that the critical access hospital provides. This fee covers the overhead of the outpatient clinic such as nursing support, medical supplies and space for the remote consult.  In this example approx.. 20% of patients get referred to the Dermatologist for follow ups such as biopsies, while at the same time the Dermatologist can bill the patients insurance company for the professional services rendered.  The critical access hospital benefits in that they too get the ability to perform additional tests such as lab work and at the same time are able to charge the patients insurance company for the facility and technical services provided during the visit.  Additionally, the community or critical access hospital is able to provide a wider range of medical services to their community.  Another example of this is in the provision of Speech Therapy services.  In such a case, the provider of the Speech Therapy services will charge other hospitals a one time fee for the therapy session.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''8. Outpatient Care Services''' – Medical Specialists agree to provide a variety of scheduled outpatient care services to facilities that lack the specialty.  For example, a Dermatologist has agreed to pay a critical access hospital a nominal fee per patient that the critical access hospital provides. This fee covers the overhead of the outpatient clinic such as nursing support, medical supplies and space for the remote consult.  In this example approx.. 20% of patients get referred to the Dermatologist for follow ups such as biopsies, while at the same time the Dermatologist can bill the patients insurance company for the professional services rendered.  The critical access hospital benefits in that they too get the ability to perform additional tests such as lab work and at the same time are able to charge the patients insurance company for the facility and technical services provided during the visit.  Additionally, the community or critical access hospital is able to provide a wider range of medical services to their community.  Another example of this is in the provision of Speech Therapy services.  In such a case, the provider of the Speech Therapy services will charge other hospitals a one time fee for the therapy session.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>9. Contracted Care Service Model''' – In this model a critical access hospital signs an agreement with a large tertiary care center for a particular service such as Pediatric Cardiology, Dermatology, Nephorology and/or Rheumotology.  In this example the tertiary care center pays the critical access hospital based on a contracted rate for the ability to provide services to that particular hospital.  The Tertiary care facility is willing to pay the contracted rate to become the ‘preferred-provider’ for that particular specialty, because they expect in return some of those patients will be referred to them for follow up care.   </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''9. Contracted Care Service Model''' – In this model a critical access hospital signs an agreement with a large tertiary care center for a particular service such as Pediatric Cardiology, Dermatology, Nephorology and/or Rheumotology.  In this example the tertiary care center pays the critical access hospital based on a contracted rate for the ability to provide services to that particular hospital.  The Tertiary care facility is willing to pay the contracted rate to become the ‘preferred-provider’ for that particular specialty, because they expect in return some of those patients will be referred to them for follow up care.   </div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''10. Curb Side Consults''' – Curb side consults are provided by Medical Specialists who do not have privileges to provide care in a particular hospital and who may not be licensed to provide care in the state where the patient is located.  In this case, there is no exchange of money and the Provider gives his consultancy services in Good Faith as a way to develop and foster a partnership with that particular facility and to create a referral pattern.   </div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''10. Curb Side Consults''' – Curb side consults are provided by Medical Specialists who do not have privileges to provide care in a particular hospital and who may not be licensed to provide care in the state where the patient is located.  In this case, there is no exchange of money and the Provider gives his consultancy services in Good Faith as a way to develop and foster a partnership with that particular facility and to create a referral pattern.   </div></td></tr>
<tr><td colspan="2" class="diff-lineno">Line 28:</td>
<td colspan="2" class="diff-lineno">Line 29:</td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>12. Revenue Sharing Model''' – this model overlaps with the reimbursement model, but in this case a PSO contracts with a number of medical specialists and manages all the billing for the services that are provided.  In exchange for the specialists services who may already be getting paid based on a contracted shift rate model, the PSO will also give the provider as much as 80% of the money collected from third party insurance companies.</div></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"><div>12. Revenue Sharing Model''' – this model overlaps with the reimbursement model, but in this case a PSO contracts with a number of medical specialists and manages all the billing for the services that are provided.  In exchange for the specialists services who may already be getting paid based on a contracted shift rate model, the PSO will also give the provider as much as 80% of the money collected from third party insurance companies.</div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>13. Night time Nocturnist / Hospitalist program.'''  In this model all patients that arrive to an Emergency Department are evaluated by a Nurse Practionner or midlevel care provider.  Many critical access hospitals and small community hospitals do not have a trained Emergency Room doctor on site 24/7.  In such a location, a remote Nocturnist is made remotely available.  Once the patient is admitted into the facility, the Norturnist can provide and bill for his service and ensure the patient gets transferred into the most appropriate department.  </div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''13. Night time Nocturnist / Hospitalist program.'''  In this model all patients that arrive to an Emergency Department are evaluated by a Nurse Practionner or midlevel care provider.  Many critical access hospitals and small community hospitals do not have a trained Emergency Room doctor on site 24/7.  In such a location, a remote Nocturnist is made remotely available.  Once the patient is admitted into the facility, the Norturnist can provide and bill for his service and ensure the patient gets transferred into the most  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>appropriate department.  </div></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>14. Group Purchasing Model''' – I am not aware of this model being used as of today but it certainly has potential.  In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time.  Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase.  As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''14. Group Purchasing Model''' – I am not aware of this model being used as of today but it certainly has potential.  In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time.  Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase.  As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
</table>Yluriehttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=9658&oldid=prevYlurie at 09:33, 4 March 20112011-03-04T09:33:51Z<p></p>
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<td colspan='2' style="background-color: white; color:black; text-align: center;">← Older revision</td>
<td colspan='2' style="background-color: white; color:black; text-align: center;">Revision as of 09:33, 4 March 2011</td>
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<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>Telemedicine <del class="diffchange diffchange-inline">is slowly becoming widely recognized as both cost and clinically effective.  Insurance reimbursement varies from state to state.  One of the main factors hindering the widespread adoption of telemedicine is that much of the services are not being adequately reimbursed.  Reimbursement rates and percentages of cases that are being reibursed for are not being tracked well.  In some cases such as a Grande Ronde Hospital, all their cases have been reimbursed.  While at Palm Drive Hospital in Sepastopol, CA only about 10% of their cases are being reimbursed.  When developing a business case for telemedicine, it is important that other reimbursements streams be evaluated.  Here are some options:</del></div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins>Telemedicine <ins class="diffchange diffchange-inline">Service Business Models'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">== Headline text ==</ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">'''1. Reimbursement:''' Federal, State and Private Insurance Reimbursement.  See list of CPT codes and State regulatory requirements below.</del></div></td><td colspan="2"> </td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del class="diffchange diffchange-inline">'''2</del>. <del class="diffchange diffchange-inline">Per Click:''' A Referring site should consider paying </del>a <del class="diffchange diffchange-inline">'per consult' or 'per-click' payment scheme</del>. <del class="diffchange diffchange-inline"> For example, when contracting </del>for <del class="diffchange diffchange-inline">Dermatology services</del>...</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">Telemedicine is now becoming widely recognized as both cost and clinically effective</ins>. <ins class="diffchange diffchange-inline">Insurance reimbursement varies from state to state. One of the main factors hindering the widespread adoption of telemedicine is that much of the services are not being adequately reimbursed. Reimbursement rates and percentages of cases that are being reimbursed for are not being tracked well. In some cases Medicare is reimbursing at </ins>a <ins class="diffchange diffchange-inline">rate 100% for all submitted claims while in others the reimbursement rate is closer to 40%</ins>. <ins class="diffchange diffchange-inline">When developing a business case </ins>for <ins class="diffchange diffchange-inline">telemedicine, it is important that other reimbursements streams be evaluated</ins>. <ins class="diffchange diffchange-inline">Two terms that will be used frequently in this discussion is the Hub or Provider Site, and the Spoke or Patient Site</ins>. <ins class="diffchange diffchange-inline">In many cases more then one model can be used at the same time</ins>. <ins class="diffchange diffchange-inline">  There are also some overlap between the different models. The goal of this article is to help organizations develop profitable and sustainable business models to support a hospital-to-hospital based clinical telemedicine program.  Here are some telemedicine business models that have been proven to work: </ins></div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''3. On-Call Payment.'''  in example when <del class="diffchange diffchange-inline">contracting </del>for <del class="diffchange diffchange-inline">a Remote </del>ICU <del class="diffchange diffchange-inline">service</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''<ins class="diffchange diffchange-inline">1. Third Party Insurance Reimbursement:''' Federal, State and Private Insurance Reimbursement. See list of CPT codes and State regulatory requirements below.  Using the reimbursement model the Spoke site is able to charge both a facility and technical fees associated with the patient visit.  The type of private insurance company that reimburses for the telemedicine services vary from state to state, but all states are able to charge Medicare.  In California for example all private insurance companies are mandated to reimburse for telemedicine services at the same rate as they do for in person services.  The Hub site whom provides the Professional service remotely submits a CPT code based claim using a modifier - GT.  There are many nuances to Reimbursement and each facility will need to understand the requirements before they adopt it.  For example, in order to bill insurance companies, in many instances the Professional who provides the consult must be licensed in the state that they are providing the services to and must be credentialed as an on-site physician within the patient site.  The patient that is being consulted on must also be first admitted as a Patient to the Spoke site, before the Hub site can bill for their professional services.  An example of this has been born out for Oncology services.  In such a model, the Oncologist (Hub) provides remote cancer care and can bill Medicare or any qualifying private insurer for his services.  The Receiving site (Spoke) can bill the patients insurance companies for the chemotherapy drugs they administer and any other tests that end up being needed such as laboratory.  In this case, the patient is not getting charged anymore then they would have if they were seen in person by the Oncologist.  The patient will save money and time by not having to drive out of town to see the Oncologist who practices in a far away city.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">2. Per Click:''' This is a one-time fee paid by the Spoke/Patient site for each consult provided by a Specialist.  A Hub/Consultant site should consider a 'per consult' or 'per-click' payment model if they have a large number of Medical Professionals who are already taking call every night for their existing facilities and have the extra manpower to provide additional services to locations who are understaffed.  For example a Hub might have several Intensivist working at a facility over a 24/7 basis who could meet a larger patient load.  The Hub could contract for these Intensivists to be remotely on-call to cover ICU patient located at other facilities.  Whenever a facility needs an ICU consult, they would call the Hub of Specialists and pay the Specialists for each consult that is provided to them.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>3. On-Call <ins class="diffchange diffchange-inline">/ Shift </ins>Payment.''' <ins class="diffchange diffchange-inline">A per shift fee is paid to one or Medical Specialists to be remotely on-call for a particular site. </ins> <ins class="diffchange diffchange-inline">For example, a Stroke Neurologist can be paid a fixed on-call fee for being available to provide a remote consult </ins>in <ins class="diffchange diffchange-inline">the event that a patient presents to the Emergency Room with stroke symptoms.  The Spoke site will pay the Stroke Neurologist a fixed fee for that shift and the Stroke Neurologist will provide as many consults that are required during that shift.  This model can be combined with a Reimbursement model, as at the same time both sites can bill for their services.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">4. Shared Resource Payment'''. In this model, the Spoke site and in some cases the Hub site share the costs of the telemedicine equipment.  Both sites form a partnership with a letter of understanding that the results of the telemedicine program will benefit both sites in-kind, and as such, no exchange of money is required.  For this model to work, a win-win situation must be created.  For both sites to win, they need to ensure the patient receives the best care possible.  This is a model that works well for a variety of patient populations such as stroke and neonatal care.  In the </ins>example <ins class="diffchange diffchange-inline">of a stroke population, the Spoke site ‘wins’ if they can keep a larger proportion of stroke patients in their facility by having a remote consultant overseeing their care.  The Hub site ‘wins’ in that they can be sure that only the most needy patients are referred/transferred to them for care.  The patient transfer may result in interventions, operations and rehabilitation services.  The patient wins in that they get transported only </ins>when <ins class="diffchange diffchange-inline">necessary and in either case will remain in the location that is best suited to care </ins>for <ins class="diffchange diffchange-inline">their illness.  This has also been proven for Neonatal care.  In many cases Spoke sites are not equipped to handle high risk pregnancies and the complications that follow and if something goes wrong the baby needs to be transported to the closet neonatal </ins>ICU <ins class="diffchange diffchange-inline">possible.  By having a remote Neonatologist involved with the high risk birth and delivery they can prepare the necessary resources to ensure that everyone is ready for the transfer of the baby and the mother will feel comforted that their baby is being well taken care of.  As the cost of the telemedicine equipment and services can sometimes be very expensive, a Hub in many cases elects to pay for all equipment for the first year or two.  This gives the Spoke site less risk and gives them time to prove the profitability of the partnership. In many cases it can take up to 6 months to get a clear ROI on telemedicine.  Care must be taken to ensure that Stark Law is not violated when using this model</ins>.</div></td></tr>
<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div>'''<del class="diffchange diffchange-inline">4</del>. <del class="diffchange diffchange-inline">Win</del>-<del class="diffchange diffchange-inline">Win Payment</del>.'''  In <del class="diffchange diffchange-inline">some cases </del>the <del class="diffchange diffchange-inline">increased </del>number of <del class="diffchange diffchange-inline">referrals to </del>the <del class="diffchange diffchange-inline">Referral </del>site <del class="diffchange diffchange-inline">(hub) from </del>the <del class="diffchange diffchange-inline">Originating </del>site <del class="diffchange diffchange-inline">(spoke) </del>can <del class="diffchange diffchange-inline">support </del>the <del class="diffchange diffchange-inline">service</del>.  <del class="diffchange diffchange-inline">For </del>example <del class="diffchange diffchange-inline">in </del>the <del class="diffchange diffchange-inline">case </del>that a <del class="diffchange diffchange-inline">Hub wants </del>to provide <del class="diffchange diffchange-inline">Stroke Services </del>to a Spoke site <del class="diffchange diffchange-inline">(rural health care </del>facility<del class="diffchange diffchange-inline">)</del>, the <del class="diffchange diffchange-inline">increased number </del>of <del class="diffchange diffchange-inline">referrals </del>and <del class="diffchange diffchange-inline">procedures itself </del>is <del class="diffchange diffchange-inline">enough </del>of <del class="diffchange diffchange-inline">an incentive </del>for the <del class="diffchange diffchange-inline">Hub site </del>to <del class="diffchange diffchange-inline">offer </del>the services for <del class="diffchange diffchange-inline">free</del>.  In <del class="diffchange diffchange-inline">many cases </del>the <del class="diffchange diffchange-inline">Hub site can afford </del>to pay for the <del class="diffchange diffchange-inline">telemedicine equipment</del>.  <del class="diffchange diffchange-inline">The </del>Spoke site <del class="diffchange diffchange-inline">wins </del>in <del class="diffchange diffchange-inline">by being able </del>to <del class="diffchange diffchange-inline">keep some </del>of <del class="diffchange diffchange-inline">their </del>patients and <del class="diffchange diffchange-inline">having them treated </del>on<del class="diffchange diffchange-inline">-</del>site <del class="diffchange diffchange-inline">rather then loosing those </del>patient <del class="diffchange diffchange-inline">days</del>.</div></td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''<ins class="diffchange diffchange-inline">5</ins>. <ins class="diffchange diffchange-inline">Grants''' </ins>- <ins class="diffchange diffchange-inline">In this model, a Government or Privately funded grant is awarded and used to develop a telemedicine service line</ins>. <ins class="diffchange diffchange-inline"> This model is useful to cover the upfront costs in starting a telemedicine partnership but can only serve as a bridge to the development and validation of a sustainable business model.  All grants should begin with a sustainable model in mind.  Too many grants have failed because a sustainable business model was not created. </ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div>'''</div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">6. </ins> <ins class="diffchange diffchange-inline">Subscription''' - </ins>In <ins class="diffchange diffchange-inline">this model a Spoke site subscribes to one or more services from a Tertiary or Specialty care group/site.  They may for example subscribe for Infectious Disease, Intensivist Coverage, Hospitalist coverage, Cardiology services.  As such they will pay a monthly subscription fee for </ins>the <ins class="diffchange diffchange-inline">service and as part of the subscription will be provided a certain </ins>number of <ins class="diffchange diffchange-inline">consults during that month.  This can also be combined with </ins>the <ins class="diffchange diffchange-inline">‘per-click’ model.  An example of this model is a Critical Care service company that provides 24x7 Intensivist services.  The Spoke/Patient </ins>site <ins class="diffchange diffchange-inline">pays a monthly ‘retaining or subscription fee’ and every time </ins>the <ins class="diffchange diffchange-inline">Spoke </ins>site <ins class="diffchange diffchange-inline">calls for a consult they also pay a one time consult fee so long as the consult is less then 1.5 hours long.  The Spoke sites have benefit from a strong ROI from this model as they </ins>can <ins class="diffchange diffchange-inline">increase </ins>the <ins class="diffchange diffchange-inline">number of ICU bed stays in the hospital which have a dramatic effect on their bottom line</ins>.  <ins class="diffchange diffchange-inline">Another </ins>example <ins class="diffchange diffchange-inline">of this model involves </ins>the <ins class="diffchange diffchange-inline">use of PSOs – Professional Service Organizations – These are specialized and dedicated service organizations </ins>that <ins class="diffchange diffchange-inline">provide </ins>a <ins class="diffchange diffchange-inline">variety of telemedicine service lines.  Many PSOs today are providing Stroke, Hospitalist or Intensivist services. They may also contract with other independent specialists such as Psychiatrists, Nephrologists, and Infectious Disease Specialists </ins>to provide <ins class="diffchange diffchange-inline">added value </ins>to <ins class="diffchange diffchange-inline">their customers.  For </ins>a <ins class="diffchange diffchange-inline">monthly fee you can contract with such an organization to provide specialized staff coverage for any of your departments.  Many of these companies work on a monthly subscription fee and may also tie in a per-click consult fee on top of that.  When contracting with such organizations all the Professionals providing consults must be licensed to practice in your state and in many cases must also have privileges in your hospital.  Such organizations may also bill insurance companies for their services.  In most cases the PSO services result in allowing the </ins>Spoke site <ins class="diffchange diffchange-inline">to keep more patients within their </ins>facility <ins class="diffchange diffchange-inline">and results in increased census.  This has become a very popular and profitable solution.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">7. Staff Efficiency''' – In this model there is no Hub site per se and generally no third party contracts.  A hospital purchases the telemedicine equipment to provide their existing staff with tools to better manage their patients.  For example</ins>, <ins class="diffchange diffchange-inline">in one large academic medical institute, telemedicine is used by </ins>the <ins class="diffchange diffchange-inline">Neurological Intensivist to round on patients at night while the Dcotor is at home.  Providing extra night-time rounds has resulted in a decrease in patient bed days and reduced complications </ins>of <ins class="diffchange diffchange-inline">patients at night time allowing the Doctor to get more undisturbed sleep </ins>and <ins class="diffchange diffchange-inline">night time pages.  Another example of this </ins>is <ins class="diffchange diffchange-inline">allowing employed Hospitalist provide services remotely.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''8. Outpatient Care Services''' – Medical Specialists agree to provide a variety </ins>of <ins class="diffchange diffchange-inline">scheduled outpatient care services to facilities that lack the specialty.  For example, a Dermatologist has agreed to pay a critical access hospital a nominal fee per patient that the critical access hospital provides. This fee covers the overhead of the outpatient clinic such as nursing support, medical supplies and space </ins>for the <ins class="diffchange diffchange-inline">remote consult.  In this example approx.. 20% of patients get referred </ins>to the <ins class="diffchange diffchange-inline">Dermatologist for follow ups such as biopsies, while at the same time the Dermatologist can bill the patients insurance company for the professional </ins>services <ins class="diffchange diffchange-inline">rendered.  The critical access hospital benefits in that they too get the ability to perform additional tests such as lab work and at the same time are able to charge the patients insurance company </ins>for <ins class="diffchange diffchange-inline">the facility and technical services provided during the visit.  Additionally, the community or critical access hospital is able to provide a wider range of medical services to their community.  Another example of this is in the provision of Speech Therapy services</ins>.  In <ins class="diffchange diffchange-inline">such a case, </ins>the <ins class="diffchange diffchange-inline">provider of the Speech Therapy services will charge other hospitals a one time fee for the therapy session.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">9. Contracted Care Service Model''' – In this model a critical access hospital signs an agreement with a large tertiary care center for a particular service such as Pediatric Cardiology, Dermatology, Nephorology and/or Rheumotology.  In this example the tertiary care center pays the critical access hospital based on a contracted rate for the ability to provide services to that particular hospital.  The Tertiary care facility is willing </ins>to pay <ins class="diffchange diffchange-inline">the contracted rate to become the ‘preferred-provider’ </ins>for <ins class="diffchange diffchange-inline">that particular specialty, because they expect in return some of those patients will be referred to them for follow up care.  </ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''10. Curb Side Consults''' – Curb side consults are provided by Medical Specialists who do not have privileges to provide care in a particular hospital and who may not be licensed to provide care in </ins>the <ins class="diffchange diffchange-inline">state where the patient is located</ins>.  <ins class="diffchange diffchange-inline">In this case, there is no exchange of money and the Provider gives his consultancy services in Good Faith as a way to develop and foster a partnership with that particular facility and to create a referral pattern.  </ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div> </div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''11. Medicare Cost Reporting Medical Department Director Fee''' – In this model a monthly fee is charged to a </ins>Spoke site <ins class="diffchange diffchange-inline">to cover the costs of providing a remote Medical Director to supervise the particular department, such as an ICU.  Third party payers are not billed </ins>in <ins class="diffchange diffchange-inline">this model and the monthly directorship stipend covers all telemedicine services provided </ins>to <ins class="diffchange diffchange-inline">that site.  The Director fee can be recorded in the hospitals Medicare Cost Report which allows them to be reimbursed a percentage </ins>of <ins class="diffchange diffchange-inline">this cost based on the population of medicare </ins>patients <ins class="diffchange diffchange-inline">in that facility.  For example, if 40% of the facilities patients are medicare, that hospital can get 40% of the Medical Director department fees reimbursed by Medicare.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">12. Revenue Sharing Model''' – this model overlaps with the reimbursement model, but in this case a PSO contracts with a number of medical specialists </ins>and <ins class="diffchange diffchange-inline">manages all the billing for the services that are provided.  In exchange for the specialists services who may already be getting paid based on a contracted shift rate model, the PSO will also give the provider as much as 80% of the money collected from third party insurance companies.</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">13. Night time Nocturnist / Hospitalist program.'''  In this model all patients that arrive to an Emergency Department are evaluated by a Nurse Practionner or midlevel care provider.  Many critical access hospitals and small community hospitals do not have a trained Emergency Room doctor </ins>on site <ins class="diffchange diffchange-inline">24/7.  In such a location, a remote Nocturnist is made remotely available.  Once the </ins>patient <ins class="diffchange diffchange-inline">is admitted into the facility, the Norturnist can provide and bill for his service and ensure the patient gets transferred into the most appropriate department. </ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">'''</ins></div></td></tr>
<tr><td colspan="2"> </td><td class='diff-marker'>+</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #a3d3ff; vertical-align: top; white-space: pre-wrap;"><div><ins class="diffchange diffchange-inline">14. Group Purchasing Model''' – I am not aware of this model being used as of today but it certainly has potential.  In this model a number of small hospitals pool their resources in order to contract with a third party company such as a PSO, Tertiary Service Provider or Specialty group to be on-call for all the facilities at the same time.  Instead of each facility individually paying a single provider organization a on-call shift payment, they all subscribe and bundle for the same service allowing each to leverage each other in a group purchase.  As a result that Provider group gets paid one fee to be on-call for all the hospitals at the same time. This single fee payment mechanism allows the stacking of sites under a single service contract</ins>.</div></td></tr>
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<tr><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td><td class='diff-marker'> </td><td style="background-color: #f9f9f9; color: #333333; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #e6e6e6; vertical-align: top; white-space: pre-wrap;"></td></tr>
<tr><td class='diff-marker'>−</td><td style="color:black; font-size: 88%; border-style: solid; border-width: 1px 1px 1px 4px; border-radius: 0.33em; border-color: #ffe49c; vertical-align: top; white-space: pre-wrap;"><div><del style="font-weight: bold; text-decoration: none;">(Still being edited. ...Under development......Hope to have article finalized soon.......)</del></div></td><td colspan="2"> </td></tr>
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</table>Yluriehttp://clinfowiki.org/wiki/index.php?title=Telemedicine_reimbursement&diff=9647&oldid=prevNdgoldstein at 15:46, 3 March 20112011-03-03T15:46:02Z<p></p>
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