Common Medical Billing Challenges Related To Telemedicine
                     COMMON MEDICAL BILLING CHALLENGES RELATED TO 
TELEMEDICINE
Medical technologies have developed not only in terms of 
equipment but also in providing healthcare services at the ease of 
one’s hand. Telemedicine is a term referring to giving medical 
advice and prescriptions via video calling or other convenient 
methods.
Tele-Medicine practice has reached to more than three-fourths of 
the hospitals in the United States. The practice of telemedicine 
reduces costs and is convenient for the patient.
The combination of technology and healthcare skills raises 
questions for the insurers as to how much should they cover for 
their clients. Some insurance companies cover the telehealth costs 
to a certain extent, while others resist paying anything.
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Specific conditions for reimbursement are required :
Insurance firms have highlighted a few requirements for the 
telehealth service to be reimbursable. Medicare, the federal 
program providing healthcare to differentially abled and above 65 
residents, requires the beneficiaries to be living in certain rural or 
outside a metropolitan statistical region to be considered for 
reimbursement.
Moreover, the patient needs to be present at a nearby “originating 
site”, which includes nursing homes or rural health clinics, etc.
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Lack of pay parity: 
The terms and conditions of private insurance providers do not 
guarantee payment similarity in the telemedicine and in-person 
scenarios.Most US states allow private insurers to reimburse 
medical costs while emphasizing that refunded amount should not 
exceed the cost of reimbursement if the beneficiary were treated 
in-person.No enforcement is provided on the parity laws in these 
states, while others do not allow private insurers to stand for 
reimbursements.
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Insufficient information about various insurance providers: 
Although insurance providers such as Medicare, Medicaid and private 
insurance companies fall under the same jurisdiction, the rules related to 
medical billing of telehealth services may be completely contrasting. Not all 
insurances have caught with the trend of telemedicine, while others face great 
discretion in setting a fixed value to reimburse for telehealth facilities.
Lack of expertise of the Telehealth provider: 
Telemedicine could greatly boost the costs of treatment if the telemedical staff 
misdiagnoses the beneficiary. It could raise the stakes for reimbursement to be 
covered by the insurer. Quality of counselling may greatly vary from one 
provider to the other. Wrong or unnecessary prescriptions could lead to a 
worse health condition of the patient, due to which he might have to attend 
urgent care. This unnecessary billing leads to the discretion of the insurance 
firms.
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Role of intermediaries: 
These are links between the healthcare facility and the patient. These vendors provide technology 
to transfer a required service from the provider to the beneficiary over long distances.
The insurers need to attend to the costs of the links as well because they need to provide 
reimbursement for healthcare service as well as technology.
Conclusion:
While attending to the funding obstacles, it would be a reasonable consideration that 
telemedicine has also provided effective results, as in the case of the decreasing number of 
patients in the emergency rooms. In this healthcare scenario, on the front-end, expert education 
of the medical practitioners should be considered.
This will help the patient to gain useful knowledge and will lead to a decrease in the discretion of 
insurers for telemedical reimbursements.
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