Reimbursement History
Reimbursement as of January 23, 2001
Reimbursement as of October 1, 2001

As of January 23, 2001, for GSTP facilities only

Medicaid will:
  Pay a "presenting provider" for an "office visit" as long as the provider has a Medicaid billing number.
  Pay a consulting provider a "consultation fee" as long as a clinician presents the patient. (*The clinician must be a licensed clinical professional such as an MD, PA, NP, RN, LPN or SW).
  Pay the hospital where the patient is located a facility fee equivalent to that facility's ER visit rate.

Medicare will:
  Pay a "presenting provider" for an "office visit" as long as the provider has a Medicare billing number.
  Pay a consulting provider a "consultation fee" as long as a clinician presents the patient. (*See description of a clinician above, and additional description below.)
  Pay the hospital where the patient is located a facility fee equivalent to that facility's ER visit rate.
  Pay facilities of allied health providers (such as physical and occupational therapists) reimbursement rates equal to what the allied health provider's fee would be.  Payment is on an annual basis.

Clinicians listed under section 1842(B)(18)(C) of the Social Security Act are eligible for reimbursement.  

Private Insurers:
More than 150 private insurers in the state are reimbursing for health care services provided via the GSTP.

As of October 1, 2001  (H.R. 5661:  Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act of 2000 (Telehealth provisions), signed into law by President Clinton on December 21, 2000, pending HCFA implementation rules)

  Elimination of Presenter Requirement:  A clinician (as described above) is not required to present the patient to the consulting provider unless it is medically necessary.
  Facility Fee for Originating Site:  A facility fee of $20 is to be paid to the originating (patient's) site.
  Physician Reimbursement: No change to what the HCFA currently provides to GSTP participants.
  Eliminates fee splitting (a practice GSTP providers did not have to implement because of the HCFA Reimbursement Demonstration benefits.)
  Store and Forward:  HCFA will continue to withhold reimbursement for care provided using store and forward technologies, except for telemedicine demonstration (federally funded) programs in Alaska and Hawaii.
  The originating site must be the office of a physician or practitioner, a critical access hospital, rural health clinic, federally qualified health center, or a hospital, and must be located in an area designated as a rural Health Professional Shortage Area, in a county not included in a Metropolitan Statistical Area or an entity participating in a telemedicine demonstration (federally funded) program as of 12/31/2000.
  Eligible telehealth services include professional consultations, office visits and office psychiatry services (identified by July, 2000 with particular HCPCS codes by the Secretary.  An annual review by the Secretary and addition or deletion of these services and codes will occur.)
  Home health services: Home health agencies may use prospective payment dollars to pay for home health services.  A telehomecare visit will not count as a visit for purposes of triggering an increase or decrease in the level of payment.  

For additional information, please contact Becky Godbee,  Clinical/Educational Services Coordinator, Center for Telehealth, Medical College of Georgia, 706-721-6616, or bgodbee@mcg.edu.

SOURCES:  Center for Telemed Law; the Office for the Advancement of Telehealth, DHHS; H.R. 5661.