ISMA urges private insurers to create parity for telehealth ‘house calls’
Since the outbreak of the COVID-19 pandemic, the ISMA Government Relations team has held frequent discussions with representatives from private insurance companies to advocate for greater telemedicine flexibility. ISMA is urging all payers to give clear and specific direction on billing that creates “parity” for telehealth visits with flexibility that includes telephone-only service, so physicians are reimbursed at the same rate as in-person office visits.

UnitedHealthcare (UHC) and Cigna are two companies that ISMA applauds as leaders in this practice. UHC, for example, has waived audio-video requirements and will reimburse telehealth services through live, interactive audio-visual or audio-only transmission to patients. Similarly, Cigna’s directives allow for services by phone, video or both.

Furthermore, these companies pay for audio-visual and audio-only telemedicine modalities at in-person rates using Evaluation and Management (E/M) codes 99201-99215.

Indiana Medicaid also reimburses for audio-visual and audio-only patient visits at in-person rates. This policy applies to both Medicaid fee-for-service and Medicaid managed care plans. ISMA has expressed appreciation for Gov. Eric Holcomb and his administration’s quick response through a series of executive orders that have allowed telemedicine to become a real option for Hoosier patients.

Although progress is being made and many health-insurance plans have expanded telemedicine coverage to include audio-only visits, not all payers have publicly stated they will pay for audio-only services at in-person rates. This could be a barrier for lower-income or older Hoosiers who may not have technology available to participate in an audio-visual telemedicine visit.

“Not every patient has the ability to FaceTime, Skype or Zoom with their doctor,” said ISMA Executive Vice President Julie Reed, JD. “While some insurers have been quick to adapt and ensure all Hoosiers get the medical care they need by using the technology they can afford, every private payer must do their part during this public health emergency.”

Despite the COVID-19 crisis, telemedicine providers are still subject to the same standards of appropriate practice for health care services provided at an in-person setting.

Since the outbreak of the coronavirus, nearly every type of business has been impacted, including physician practices. Many appointments and elective procedures have had to be canceled to preserve limited supplies needed to fight the coronavirus surge.

Once clear parity between telehealth and in-person visits is established, patients can continue to receive preventive medical care that will keep them out of hospital emergency rooms, and doctors can continue to keep their practices open for business.