Clinical Services

Workshop Presentation

(WP-03) Reimbursement 101: How to Get Paid

Tuesday, April 25
10:45 AM - 11:45 AM
Location: W224 AB

Medicare, Medicaid, and private health plan payment for Telehealth or virtual care is often misunderstood by TeleHealth providers. This presentation takes a simple, straight-forward approach to helping the participant understand how to determine whether or not services are covered via TeleHealth by CMS. The RUCA calculator for rurality is covered with specific examples shown. CMS CPT codes and explanations of how these codes are used/modified/updated is explained to the session participants, as well as how to apply MSA and urban rules. Medicaid is often trickier as each state applies its own set of rulemaking to paying for services delivered via TeleHealth. The difference between CMS Medicare and state-based Medicaid payment is discussed. Specific state examples are covered to ensure that participants understand how to interpret 'good' and 'vague' Medicaid language. Parity laws are discussed as these rules apply to private payers, Medicaid and Medicare. Participants will have ample time to ask questions about specific examples. With so many new comers to Telehealth, understanding government payers is a topic that never grows old. With annual changes to Medicare reimbursement, and the growing number of states that are instituting or amending Medicaid rules, even experienced TeleHealth programs have a need to understand the new rules. The session will cover the new 2017 requirements for CMS, Medicaid (some state examples) and movement of state's Office of Insurance Commissioners and NCQA to using TeleHealth in calculations of network adequacy. The two new bundled payment systems that include the use of TeleHealth in the home will also be highlighted. Chronic care management codes and TeleHealth is still greatly misunderstood and examples of how to use and bill these codes will be reviewed. This session provides a comprehensive overview of government and private payer reimbursement and gives the participant additional resources to use after the session is complete.

Learning Objectives:

Nina M. Antoniotti

Executive Director for TeleHealth and Clinical Outreach
SIU Medicine

Dr. Nina Antoniotti is SIU Health Care’s Executive Director of TeleHealth and Clinical Outreach. Dr. Antoniotti received her diploma in Nursing from Akron General Medical Center, Akron Ohio; her Bachelors degree in Health Care Administration from St. Joseph’s College, Windham Maine; her Masters in Business from Cardianl Stritch College, Milwaukee, WI; and her Doctorate in Organizational Systems from Saybrook University in California.

Dr. Nina Antoniotti, is an internationally known leader in TeleHealth; is past Chair of ATA Standards and Guidelines Committee; past ATA Board Member, past-chair of ATA’s Policy Committee; and past VP of the Board of the Center for Telemedicine Law in Washington, DC. She currently serves ATA in many capacities, and is on the Standards and Guidelines Committee.

In 2007, Dr. Antoniotti received ATA’s President’s Award for Individual Achievement in advancing Telemedicine world-wide. She has been instrumental in developing sustainable models of TeleHealth with expertise in clinical operations, innovative deployment of technology, legal and regulatory issues in virtual care, public policy initiatives, and all aspects of delivering care at a distance. Dr. Antoniotti has many innovative was to cost effectively implement successful TeleHealth strategies in all health care settings.

In 2009, Dr. Antoniotti was inducted into ATA’s College of Fellows for contributions to the world of telemedicine and advancing virtual care around the globe. Dr. Antoniotti is also known for her work on deploying Telemedicine in China and Iran. Dr. Antoniotti is very well known for her willingness to help others be successful in their TeleHealth initiatives and in her vast knowledge used in consulting with organizations in starting, managing, and improving outcomes associated with the use of TeleHealth.


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(WP-03) Reimbursement 101: How to Get Paid

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