Virginia Reimbursement for Telehealth

Virginia's parity law mandates private insurance and state managed health plans to reimburse for telemedicine. Under DMAS guidelines, the originiating site (patient site) may also bill for a facility fee to help offest costs of staffing and technology.  This is added revenue for your organization.

"Telemedicine is the real-time or near real time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment. The Medicaid member is located with a provider at the “originating” site, while the “remote” provider renders services via the audio/video connection." 

2019 Update regarding DMAS coverage of Telehealth and Telemedicine

Some specifics:

1. A DMAS enrolled provider is as the distant site
2. The Member is located at DMAS-recognized originating site
3. The originating site provider cannot bill an originating site fee unless the Member is assisted by a telepresenter at the originating site. The telepresenter need not be a clinically trained individual, unless medical expertise is clinically indicated to address any patient needs that may arise during the telemedicine session. Where an originating site fee is not sought, a telepresenter need not be present for reimbursement of the telemedicine service fee.

In addition, Home Health Services can bill DMAS for In home telehealth visits with the provider following these guidelines,

"The face-to-face encounter (with the Home health services provider) may occur through telehealth, which is defined as the real-time or near real-time two-way transfer of medical data and information using an interactive audio/video connection for the purposes of medical diagnosis and treatment."

-April 2018 Medicaid Document in Virginia

For a great summary of what you need to know from the 2016 Telehealth law in Virginia, click here

At Secure Telehealth, we have over 10 years of experience helping organizations implement successful telehealth programs.  We fully manage your telehealth program so you don't have to.  Your patients work directly with us to get set up for their first appointment. When they have questions or technical problems, they call us so that none of your time is wasted and appointments are not missed.