Doctors Struggle to Get Paid for Telehealth Visits

Telehealth usage during the COVID-19 pandemic has increased rapidly, compared with its previously slow uptake. In fact, telemedicine provider Amwell said that as of March 31, 2020, usage of its app was up 158 percent since January. In some hard-hit areas like Washington, app usage was up by as much as 700 percent at times.

But despite the promises of increased reimbursement from the federal government and from private insurers, providers say they’re not being paid what they were promised, and certainly nowhere near what they made with in-person visits. Some of this is due to a lack of clear information, and some of this is because the country’s many insurance plans each have different policies about telehealth reimbursement.

“It’s been very, very confusing,” Todd J. Maltese, DO, who runs a Long Island sleep medicine and neurology practice with three providers, told MedPage Today. “There’s no standard way of doing this. Every insurance company, they’re asking for different codes and modifiers.”

The pandemic forced public and private payers to start reimbursing more types of telehealth appointments, primarily because most Americans are being ordered to stay home.

The Centers for Medicare & Medicaid Services (CMS) promised that Medicare would reimburse providers at 100 percent of the in-person rate for most of these virtual visits, and private payers followed. But according to providers, analysts, and other insiders, some bills are being returned and some are only being partially paid.

Telehealth coverage “used to be certain—you weren’t getting paid,” said Jefferson University VP of Healthcare Delivery Judd Hollander, MD. “Now it’s uncertain … It’s utterly confusing.”

When Dr. Maltese asked his office manager to call insurance companies about billing as it shifted to a temporary all-telehealth model, “half the companies couldn’t even give us information because they didn’t know, and it’s been a crapshoot from there,” he said. Some have paid in full, while other companies promised to reimburse at 100 percent but reimbursed for less.

Medicaid reimbursement policies for telehealth also vary from state to state, and some state Medicaid administrators have not been able to clearly state their policies. And when insurers do cover telehealth, they often send patients to top telemedicine vendors like Amwell or Teladoc, where patients see the vendors’ certified providers rather than their own personal physicians.

Amwell’s reimbursement story is a little different from those of many primary care providers. Amwell Chief Medical Officer Peter Antall, MD, said his company has not had trouble being reimbursed by its 55 private payers.

Some of the physicians interviewed for the article say they can only survive about two or three months as a mostly or completely tehelealth-based practice, and only then if they can collect most of their bills.

“It’s not like I’m saving up for a Lamborghini,” said Arthur Guerrero, MD, who runs a private practice with four providers in a small town in Texas. “I’m trying to make 100% [reimbursement] because that’s what my employees’ jobs hang on.”

Read the full story here.