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Medicare and Medicaid begin reimbursing providers for "physician to physician" telemedicine consults between MCG and Dodge County Hospital in Eastman, Georgia. Blue Cross Blue Shield also begins to reimburse for telemedicine consults.
Discussions begin with HCFA about the expansion of Medicare reimbursement to all GSTP sites. The GSTP joins a University of
Michigan-HCFA study; it is expected that Medicare reimbursement will be expanded once the study results are in.
The Telemedicine Center, manager of the GSTP, begins discussions in January with Medicaid about expanding their reimbursement policy to include all GSTP sites. Medicaid's terms are that particular billing procedures be followed and that all GSTP sites be assigned an identification number to be used when billing. In May of 1995, Medicaid agrees to reimburse all GSTP sites for "physician to physician" telemedicine consultations.
Also in 1995, HCFA awards a grant to the Center for Health Policy Research at the University of Colorado in Denver for a three year study to determine whether telemedicine is efficacious and economical. Five telemedicine programs are to be involved: East Carolina University School of Medicine, Greenville; Iowa Health System, Des Moines; Midwest Rural Telemedicine
Consportium, Des Moines; West Virginia University School of Medicine, Morgantown; and the
GSTP.
The Telemedicine Center begins negotiations with HCFA regarding GSTP participation in the study.
A presentation is delivered to the Department of Medical Assistance (DMA), administrators for Medicaid, regarding reimbursement for non-physician providers. After the presentation, the DMA requests a written proposal from the Telemedicine Center, which is submitted in October 1997.
The DMA approves expansion of reimbursement for GSTP consults. Medicaid-approved providers are eligible for reimbursement. Consulting providers are eligible for reimbursement when a licensed provider presents the patient
(LPN, RN, NP, PA, etc).
At the GSTP conference in September, discussions begin between the Telemedicine Center and the Department of Medical Assistance commissioner regarding cost savings related to telemedicine, particularly, transportation and patient out of pocket savings. Telemedicine Center staff propose the shifting of DMA transportation costs savings to struggling GSTP sites to help the sites cover transmission costs. (These discussions are ongoing.)
Negotiations with HCFA on terms of CHPR-HCFA study continue through June. The Telemedicine Center negotiates for payment to GSTP sites for research support services; the coverage of all GSTP sites, including new sites; and reimbursement to all Medicare-approved providers. Each GSTP facility is to bill HCFA directly.
In June, the Telemedicine Center begins negotiating terms of the study sub-contract with the University of Colorado.
The Balanced Budget Act of 1997 (BBA '97) becomes effective in January; it has a narrower scope of coverage.
In April, negotiation of the sub-contract terms for the CHPR-HCFA study are finalized.
In May, GSTP site coordinators are trained on procedures required for participation in the CHPR-HCFA study. The study results in new Medicare coverage. The new coverage:
 Provides full reimbursement for all Medicare-approved providers.
Is more comprehensive than BBA '97
Is effective May 7, 1997 for all GSTP sites
Requires use of Patient Data Management System
Reimbursement is dependent on agreement to participate in study, not on number of study subjects.
Reimbursement today
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.
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