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What is Telemedicine and its coverage under Medicare?

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Telemedicine, also referred to as telehealth (and sometimes telecare), is an important and growing area in the field of health care. With technology and communications improving constantly, telehealth can offer convenience and comfort to patients. According to a study at the University of Massachusetts Medical School, telehealth saves health providers money (which could result in savings to Medicare and its beneficiaries).

Medicare considers telemedicine and telehealth to encompass the use of modern technology to provide health care services to beneficiaries who are not at the same location as the health-care provider. It can involve smartphones, email, two-way video, and other technological and wireless tools.

Terms like telemedicine, telehealth, and telecare are relatively new, and not everyone uses them to mean exactly the same thing. Telehealth is often considered to have a wider scope than telemedicine; for example, it might include health education. Telecare can refer to electronic devices that support independent living, such as pendants that let you summon help.

Medicare benefits for telemedicine

As telemedicine grows in importance, so does its coverage under Medicare. Currently, Medicare Part B (medical insurance) provides coverage for telehealth under certain circumstances, depending on the type of medical service received and the location of the facility where care is received.

Medicare generally offers coverage for telemedicine services that are similar to regular interactions between health-care providers and patients. Such services include doctor visits, consultations, individual psychotherapy, and pharmacologic management. The patient has to be present, meaning that the consultation between doctor and patient has to be “face-to-face” — via two-way video, for example. There are a handful of exceptions to this rule, notably for teleradiology and remote EKG applications, where a “live” meeting between doctor and patient may not be necessary.

Another important requirement has to do with the location of the beneficiary and the health-care facility. You must be located in a Medicare-approved facility that’s outside of a Metropolitan Statistical Area, which means that you’re probably in a rural area and may have difficulty reaching your preferred health provider. The Medicare health-care provider can be located anywhere in the United States, but must be in one of the following facilities for Medicare to provide coverage:

  • Doctor’s or health provider’s office
  • Hospital or Critical Access Hospital (CAH)
  • Hospital-based dialysis center
  • Federally qualified health center
  • Rural health clinic
  • Community mental health center
  • Skilled nursing facility (SNF)

Telemedicine and the Affordable Care Act

As the Affordable Care Act (ACA) goes into force, health-care providers are facing the prospect of an increased load of patients. Telemedicine can help in this regard, allowing, on the one hand, physicians to interact with more patients in a shorter amount of time, and, on the other hand, offering patients flexibility and economic incentives, by allowing them to consult with their doctor without having to leave home or take time off work. At some point in the future, a significant portion of emergency room visits could even be handled remotely by qualified physicians.

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