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How I Practice Now: Commercial Coverage Policy Updates for Telemedicine Services

Publication: Journal of Clinical Pathways

My name is Dr. Debra Patt. I’m a vice president of policy and strategy at Texas Oncology. We are a large private practice in Texas, where we have rural and urban cancer centers (about 221 sites and services that see about half of Texans with cancer).

One of my responsibilities within the practice is I’ve helped us lift up telemedicine – which is a platform we’ve used for more than 5 years to do clinic consultations to reduce the gaps in clinical expertise that are brought on by geography across the state. Patients don’t have to move; instead, they can have telemedicine visits.

As you may realize, a certain portion of what we do is governed by payment policy and some of it is just governed by compliance law. The law has also changed to permit us to have new visits and established patient visits by telemedicine. That has been meaningful.

The other change is that it doesn’t only have to change at the federal level. Each of the 50 states has had to pass permissive policy to allow doctors in any given state to be compliant with their medical board to provide telemedicine services. I practice in the state of Texas, and Governor Abbott has been very permissive about allowing telemedicine services.

The payment piece is complex. About 80% of our payers are governed under the jurisdiction of ERISA or under federal jurisdiction. When Medicare has payment policy, frequently commercial payers will follow. But really every day, commercial payers have changed their payment policy. We get updates every day to date, almost a month after the most comprehensive telemedicine payment policy was passed from CMS. Some commercial payers have not yet liberalized their payment policy around telemedicine.

The constant flux is challenging to manage, but I’ll put that aside for a moment. Of the 80% that are governed under the ERISA jurisdiction, what Medicare and commercial payers do that fall under ERISA jurisdiction matters. At the state level, that’s about 20% or so of our plans, and they fall under state jurisdiction. In my state, Governor Abbott has been very permissive about having state policies to be more permissive of telemedicine visits and for state plans to pay for them – be they commercial or public plans.

Now, let’s go back to the commercial payers federally because them changing every day and not being comprehensive in their coverage policy around telemedicine does matter. When Texas Oncology or any practice submits a bill to an insurance company, if they change their policy a week later and it’s retroactive, we have to resubmit that bill later and it costs money. Commercial payers changing payment policy frequently means that we’re at risk for greater administrative expenditures if we have to resubmit claims over time. What would be better, and I think in the best interest of patients in this crisis and moving forward, is commercial payers be quick to act to have more comprehensive telehealth policies.

View the full story at Journal of Clinical Pathways.

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