Question Telemedicine in Hospital Setting

beccamcd7

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Anyone performing telemedicine visits as the role of a hospitalist? I'm looking for very specific info....we would like to contract with a hospital and have them pay us a flat rate for our services (diabetes management). The issue is how does the hospital itself get reimbursed for the services? They can't bill Part B but can they somehow bill a higher level MS-DRG to receive a higher level reimbursement? Any help would be appreciated as I can't find ANY data on this.
 

thomas7331

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I've been involved with a hospital using telehealth for specialist consultation, but not for hospitalists, although the process would be exactly the same. The only way the hospital can be reimbursed for your group's professional fees would be to credential your providers with their payers under their own tax ID number (as they would with any physician employed by the hospital) and bill the professional fees to Part B as a separate claim. Using physicians through telehealth does not change the DRG payment in any way because that is based on the patient's diagnoses and is not impacted at all by whether or not the patients are seen by physicians in person or through telehealth. The hospital can include a charge for the originating site facility fee for telehealth services, but this also usually does not impact payment for inpatient claims.
 

beccamcd7

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Thank you for the info! We thought maybe since they were billing for the diabetic care that they could add that onto it but I supposed that Dx would be billed by them regardless. This is helpful, thanks again!
 

thomas7331

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Thank you for the info! We thought maybe since they were billing for the diabetic care that they could add that onto it but I supposed that Dx would be billed by them regardless. This is helpful, thanks again!
You're welcome. One thing I might mention too is that it can be an advantage to a hospital to have telehealth services in that it can allow them to treat a patient in-house that they might otherwise have had to transfer to a different facility if there was no provider in-house at the time with a particular specialty. So there can be a financial benefit to the hospital in that they may be able to avoid having to refer the patient to a different facility.
 
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