Telemedicine made headlines across the world in 2020 and into 2021 and came into focus like never before. But what exactly is telemedicine and how does it work? More importantly, how can you get paid for this type of remote work?
Even if you’re not a healthcare professional, understanding the basic principles of the telemedicine revenue model is essential for launching a digital healthcare business today.
While over 90% of healthcare organizations reported fully meeting the demand for telehealth during the Covid-19 health crisis, only 20% said they would continue telehealth offerings if reimbursement levels were to return to pre-Covid levels. An additional 30% were unsure of what they would do.
In the face of this uncertainty, there is a preference to default back to the way things were. Hence the forecasted declines in telemedicine use from peak levels in April 2020, when 13% of all private medical claims were virtual.
Many practitioners have no idea how their telemedicine services are performing, let alone how to improve them. This is not surprising given how quickly organizations were forced to stand up telemedicine services during the pandemic.
Having spent much of 2020 on the frontlines of this field, I’ve seen how employers, providers, and innovators have grappled with the opportunities and decisions involved in new telemedicine initiatives.
Here’s the single most important piece of insight I can share – Stop approaching telemedicine like an add-on service and instead approach it like a stand-alone e-commerce business.
Those that can leverage today’s e-commerce tools most effectively have a huge opportunity ahead of them.
Let me share with you the successful and proven strategies that I used to launch multiple digital & virtual care programs from within the medtech industry. Let’s focus on the best revenue opportunities in telemedicine today.
Here’s how telemedicine works and how to get paid for remote services in 2022.
Telemedicine is NOT Remote Care.
One of the most helpful distinctions to understand is the notion that most physician practices today connect with patients at a distance, which is essentially remote care.
Remote care is not telemedicine, i.e., “practicing medicine at a distance.”
Too big are often the problems, too low the tolerance for non-performing technology for true medical care to be accomplished via a webcam.
The lack of basic vital signs, or the absence of organizational clinical guidelines, can quickly render even a remote care visit ineffective.
So let’s define 3 terms that are often used interchangeably:
- Remote Care – Connecting with patients at a distance
- Telehealth – Delivering care at a distance
- Telemedicine – Practicing medicine at a distance
True telemedicine has a long way to go, but that’s where the greatest revenue potential exists.
Today a majority of virtual care falls into Remote Care or Telehealth. Only a small fraction of care is Telemedicine.
A key distinguishing factor of Telemedicine is the ability to perform medical interventions that are based on a patient’s current medical state and the ability to bill and seek reimbursement for such interventions.
I’ll cover the key telemedicine billing codes and fee schedules a little later. For now, just understand that reimbursement for telemedicine services in the US, and thus revenue, is set by The Centers for Medicare and Medicaid Services (CMS).
Telemedicine platforms seek these reimbursement payments and share this revenue in a variety of ways with those providing care to patients.
There are three main types of virtual services physicians and other professionals can provide to Medicare patients:
- Medicare telehealth visits
- Virtual check-ins and
Before the COVID-19 pandemic, coverage of telehealth services under traditional Medicare was limited. Medicare paid for approximately 100 services provided by telehealth, and there were limitations on how these services could be delivered and which beneficiaries could access them.
To make it easier and safer for beneficiaries to seek medical care during the COVID-19 pandemic, the HHS Secretary waived certain restrictions on Medicare coverage of telehealth services for traditional Medicare beneficiaries during the COVID-19 public health emergency.
The waiver, effective for services starting on March 6, 2020, significantly loosened coverage restrictions for telehealth under traditional Medicare during the public health emergency and coverage now includes over 270 services.
The public health emergency was most recently renewed in April 2021, and, according to the Biden Administration, is expected to remain in place for the duration of 2021.
Separate from Medicare’s coverage of telehealth services, traditional Medicare covers brief, “virtual check-ins” (also called “brief communication technology-based services”) via telephone or captured video image, and E-visits for all beneficiaries, regardless of whether they live in a rural area. Both of these services, which were not amended during the public health emergency, are more limited in scope than a full telehealth visit.
Practitioners who can provide and claim payment for telehealth services include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.
Before the public health emergency, telehealth services were generally available only to patients in rural areas. Patients in urban areas were ineligible for telehealth services, and could not receive telehealth services in their own homes.
During the public health emergency, patients in any geographic area can receive telehealth services, and can receive these services in their own home, rather than needing to travel to a “distant site” (i.e., a health care setting).
Any health care professional that is eligible to bill Medicare for professional services can provide and bill for telehealth services, and does not need to have previously treated the patient.
Also, federally qualified health centers and rural health clinics are allowed to provide telehealth services; these settings were not authorized as providers of telehealth services for patients prior to the pandemic.
The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.
- These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
- They must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility, or hospital for the visit.
- [During COVID-19 Public Health Emergency] Starting March 6, 2020, Medicare will make payment for Medicare telehealth services furnished to patients in any healthcare facility and in their home.
- [During COVID-19 Public Health Emergency] While the current law (1135 waiver) requires an established relationship with the patient, HHS will not conduct audits to confirm this relationship for claims submitted during this public health emergency.
Established Medicare patients in their home may have a brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image.
Medicare pays for these “virtual check-ins” (or brief communication technology-based service) for patients to communicate with their doctors and avoid unnecessary trips to the doctor’s office.
These virtual check-ins are for patients with an established (or existing) relationship with a physician or certain practitioners where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available). The patient must verbally consent to receive virtual check-in services.
- Virtual check-in services can only be reported when the billing practice has an established relationship with the patient.
- Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.
- Individual services need to be agreed to by the patient. However, providers may educate patients on the availability of the service before patient agreement.
In all types of locations including the patient’s home, and all areas (not just rural), established Medicare patients may have non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals.
For these E-Visits, the patient must generate the initial inquiry and communications can occur over a 7-day period.
- These services can only be reported when the billing practice has an established relationship with the patient.
- This is not limited to only rural settings. There are no geographic or location restrictions for these visits.
- Patients communicate with their doctors without going to the doctor’s office by using online patient portals.
- The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G206, as applicable.
- The Medicare coinsurance and deductible would generally apply to these services.
Telehealth is unique in that it does not require a medical transaction to occur.
This is like a FitBit or Smartwatch that conveys interesting health metrics (like step count or pulse rate) but doesn’t have a medical diagnosis or intervention associated with it.
Telehealth isn’t technically reimbursable but can fall into the categories of consultation and advice. This is why many telehealth services work outside the health insurance framework and are paid out-of-pocket by the patient/user.
Several products are beginning to transition from telehealth to telemedicine applications, but the latter requires FDA approval so the barrier to entry is fairly high.
Typically telemedicine pays per consult, pays per hour, or pays per inbox message or text if working on asynchronous telemedicine jobs. To get paid, you can set up a direct deposit. Many telemedicine companies will pay you every two weeks for your services.
- Telemedicine physicians average $15 – $30 per video visit and can complete 3-5 video visits per hour to make $100 – $150 per hour.
- Specialty telemedicine physicians such as radiologists or cardiologists may earn upwards of $200 per hour
- Telemedicine nurse practitioners average $23 per consult for an average of $60 – $100 per hour.
- Asynchronous telemedicine pay averages from $8 – $18 per consult due to variances in the tasks, but consults are quick – typically less than five minutes. Asynchronous telemedicine can be completed on your own schedule within a 24-hour time period and is text-based.
What about physician pay at the biggest telehealth companies?
Here are some specific examples at 3 of the top telehealth platforms.
- Teladoc: $23.50 per phone visit and $28 per video visit
- Healthtap: Up to $30 per consult
- MDLive: Base salary + $10 per consult
What are the Margins in Telemedicine?
Fees can also be significantly higher, for example, $299 for an initial 45 min psychiatric consult.
This fee is covered by the patient through insurance (Medicare reimbursement) and/or out-of-pocket expenses.
Assuming an $85 fee, the physician will typically earn $25-$30 for this consultation while the remaining $55-$60 is kept by the telemedicine platform. That’s a 70.6% margin.
That margin is reduced slightly by the operating costs of the telemedicine platform (website, administration, marketing, etc) but clearly, telemedicine is a highly profitable business.
This is why operating a stand-alone telemedicine service is an attractive option for private practices and hospital systems seeking additional revenue streams.
But make no mistake operating a telemedicine service is a line of business, an e-commerce business, unto itself. It is not just a bolt-on service.
So anyone with a webcam and medical credential should be able to start making money in telemedicine, right?
Maybe in the early days, but not today. There are just so many players offering a virtual interface that it’s become more difficult to stand out. It’s difficult to know exactly what to focus on, where the most patients are, and where you fit in to maximize your earning potential.
The key to success is understanding the trends that drive the highest-paying and successful virtual care platforms. The most important trend is Specialization.
Specialization is what drives growth in telemedicine today.
The early days of telemedicine were dominated by general care and routine check-ins because triaging low-level care was simple and effective remotely.
The specialties like pediatrics, obstetrics, dermatology, ophthalmology, cardiology, endocrinology, neurology were not well set up for telemedicine. The one exception might be in mental health where specialists could still prescribe and diagnose remotely.
Today the specialties are catching up and as more telemedicine tools are introduced the ability to practice specialty care remotely is growing exponentially.
These are the highest-paying telemedicine trends that focus on specialization.
Telehealth is an effective method of care delivery for a wide range of specialties, including everything from radiology to ophthalmology to post-operative care.
The initial telemedicine wave focused on primary care while many specialty care providers struggled to adapt.
For example, ophthalmology was a segment that experienced a significant decrease, (upwards of 50% drop in patient visits) because practitioners were not ready to support a remote care model.
This was partly cultural, but also partly a lack of trusted technology available to support specialty care (for example in-home retinal exams or in-home ocular pressure measurement for Glaucoma patients).
This is changing quickly in part due to emergency use authorizations by the FDA in areas such as teleophthalmology and mental health.
Listed below are the most telemedicine-friendly specializations in the United States:
Telemedicine Family Medicine
- Hourly rate: $15 – $200 per hour
- Yearly rate: $28,000 to $386,000
- Average yearly rate: $191, 202
Primary care physicians are among the easiest practices to convert into telemedicine, with some physicians offering telemedicine-only consultation.
Common duties of a telemedicine physician include diagnosing and treating mild symptoms, providing scheduled physical check-ups, and connecting patients with other specialists.
Telemedicine Psychologists And Psychiatrists
- Hourly rate: $25 – $181 per hour
- Yearly rate: $60,000 to $300,000
- Average yearly rate: $189,000
Salary estimates for telemedicine psychologists and psychiatrists depend on their experience. Adult psychologists earn $2,000 to $5,000 more than child psychologists.
Nonetheless, both specializations are suitable for telemedicine jobs. With constant communication, psychologists and psychiatrists can encourage better compliance and cooperation with their patients, leading to higher success rates.
- Hourly rate: $30 – $200 per hour
- Yearly rate: $150,000 to $500,000
- Average yearly rate: $494,400
Teleradiology is one of the more lucrative specializations making the shift into telehealth and telemedicine, so much so that teleradiologists are earning a lot more than conventional radiologists without changing the core aspects of their profession.
- Hourly rate: $45 – $100 per hour
- Yearly rate: $45,000 to $250,000
- Average yearly rate: $190,000
Not all health issues concerning children are urgent, which is why consultations over telemedicine technology are ideal for pediatricians.
Instead of going to the hospital or the emergency room, worried parents can easily access their telemedicine physician and get much-needed, urgent advice.
- Hourly rate: $50 – $200 per hour
- Yearly rate: $50,000 to $500,000
- Average yearly rate: $464,000
Managing congenital heart diseases and reducing the risk of complications becomes easier with telemedicine.
Most cardiology care involves patient monitoring, which is now even more accessible since patients can participate in consistent remote monitoring.
- Hourly rate: $40 – $150 per hour
- Yearly rate: $150,000 to $300,000
- Average yearly rate: $175,000
Gastro conditions such as irritable bowel syndrome and hemorrhoids are typically treated as outpatient conditions.
Gastroenterologists who make the shift to become telemedicine physicians can still manage these non-emergency chronic conditions without a hospital visit. Common duties include checking for symptoms and providing prescriptions when necessary.
- Hourly rate: $30 – $200 per hour
- Yearly rate: $60,000 to $280,000
- Average yearly rate: $200,000
On top of video conferencing, endocrinologists typically use trackers and other devices to monitor glucose, blood pressure, and other data. This information will be sent directly to the hospital’s database so endocrinologists can keep track of their patient’s health remotely.
Many healthcare practitioners are already familiar with video conferencing, but what does practicing medicine through the internet look like?
You are interested in broadening the scope of care that you provide to your patients remotely which will improve the quality of care you can provide.
Maybe you’re a cardiologist whose clinical practice is in Alaska – with a population density of 1.2 people/square mile and where 75% of the communities are not connected by road to a city with a hospital.
You will improve patient outcomes and improve the patient experience since they can receive care in their own home rather than coming into a clinic during the pandemic.
You want to know what technologies are available to track my patient’s sleep, blood pressure, or ECGs? How will patients learn how to use these products at home? How can I track their progress?
You want to add Remote Patient Monitoring (RPM) to your clinical care.
- Understanding the coding and fee schedules around RPM.
- Then select an RPM provider. Several good ones offer a balance between a selection of monitoring technologies and integration with telemedicine software.
An RPM program could generate upwards of $1911 per patient annually. The exact amount depends on the patient’s locality and the specific RPM management system used.
An average range is $120-$155 a month per patient for these programs. With just 50 patients enrolled, that’s an extra $72,000-$93,000 a year of revenue potential.
Related: Read our full post on RPM Devices and Reimbursement
Consumer and clinical technologies are emerging in healthcare. Digital health products from Apple, Verily, Fitbit, Samsung, and more have gotten clearances from FDA and achieved broad adoption within the public.
Many consumers are used to their own devices and would like ways to share the data that they are already collecting with their healthcare providers.
The bring-my-own-device (BMOD) model is quickly gaining popularity. Many telemedicine and RPM providers are seeking ways to improve the compatibility of their platforms with the most popular consumer devices.
Prevounce does a particularly good job of catering to this model.
Related: Here’s our Comprehensive Guide to Getting Started in Digital Health
One specific area of this sector that is stepping into the spotlight is direct-to-consumer pharmacy and telemedicine companies, like New York, NY-based LifeMD.
Another example is digital direct-to-consumer pharmacy TruePill which provides white-label pharmacy services to health providers.
Companies like these now offer patients immediate and virtual treatment from licensed physicians, along with home delivery of prescription medications bundled with over-the-counter wellness products.
These high value services are becoming differentiators in telemedicine and both patients and providers are becoming more accustomed to accessing e-commerce enabled services like these throughout the cycle of care.
Working for a telemedicine company is one of the best ways to make extra income as a doctor, psychiatrist, nurse practitioner, or physician assistant.
There’s even a growing need for telehealth specialists like neurologists, dermatologists, and cardiologists.
The allure is obvious, you work from home (or a cafe, or even the beach!), but you can make your own schedule to fit your lifestyle and family needs and work as much or as little as you want.
Plus, telehealth jobs can be part-time or full-time, meaning you can supplement your existing salary with extra funds through telemedicine work.
The easiest option for healthcare providers looking to get started in telehealth is to sign up with a telemedicine company and start taking virtual patients.
Since telemedicine companies offer flexibility in schedules, many providers choose to work for multiple platforms. This lets you “try out” different employers and determine which companies suit your schedule, your desired patient flow, and offer the benefits or salary structure you prefer.
With the pandemic, more patients began needing remote-based care. As a result, more types of companies are entering this space to serve patients, employees, and members virtually.
There is a surprising variety of telemedicine companies out there. The key is to remain flexible and look for a fit where you can focus on the highest paying trends. Some examples include:
- Retail clinics, Direct-to-consumer pharmacies, Labs & diagnostic partners,
- Technology companies. Behavioral health organizations
- Remote patient monitoring companies
- Direct-to-consumer health navigation services
- Employee benefits platforms, Health plans, Health systems & ACOs
- Primary & urgent care services
- Condition management solutions
Here are some of the best telemedicine companies for healthcare providers
- Size: 62,000 providers are on the network.
- Features: Can browse doctor profiles, view available appointment times, and schedule an appointment with the doctor of your choice.
- Why Join: If you believe partnerships with legacy healthcare companies will be the winning formula, Amwell is for you
- Size: 7000+ Medical professionals in the network.
- Features: Teladoc Health, one of the leading telemedicine networks, saw a staggering 92% jump in visits in Q1 2020, the early days of the pandemic. This translated to a total revenue of $180 million over the time period.
- Why Join: If you believe broadening services — especially into chronic disease management — is the future of telemedicine, Teladoc should be your choice.
- Size: 2,500 doctors in-network
- Features: You can connect with patients through several channels of services like Query, Chat, Phone consultation and Video Consultation. You can also discuss medical cases with fellow iCliniq doctors.
- Why Join: iCliniq has stepped up its efforts to expand to international markets especially, UK, US and Singapore. If you want access to international markets, believe in a more collaborative healthcare community and want multi-platform options then iCliniq is for you.
- Size: 2000+ clinicians in its network
- Features: Mental health services, MDLive doctors average 15+ years of experience
- Why Join: One of MDLive’s biggest perks is the variety of doctors available on the platform. If patients have a strange rash, mole, or other skin condition, you can get the expert opinion of a certified dermatologist in just minutes. MDLive goes beyond basic urgent care with its talk therapy and psychiatric services, which can help diagnose depression, anxiety, and many other mental illnesses. If you believe access to a variety of specialties and practice areas to create a unified open system platform is important to patients, then MDLive is for you.
- Size: 700+ Medical professionals in the network.
- Features: Doctors can diagnose and treat mental health conditions and medical conditions, and write prescriptions. Patients can pick a physician or therapist, or allow the app to make a match for you. Along with being licensed and board-certified, physicians must pass quality assurance tests and undergo telemedicine training
- Why Join: Doctor on demand is widely known for its mental health expertise. The recent merger with Grand Rounds has increased Doctor on Demand’s reach into the employer market. If you believe specialization in mental health and fully integrating medical and behavioral healthcare with clinical navigation is the future, then Doctor on Demand is for you.
- Size: 500+ physicians in the proprietary network
- Features: The consultation can take place by a phone call, email or a web-based video call. This company has offerings for individual doctors, private practices, and even health systems, so their ability to scale their platform is industry-leading.
- Why Join: If the combination of general care, increasing specialization, care navigation, second opinion integration, and urgent care seems like a winning strategy for patients, then Mytelemedicine is for you.
- Size: 100+ physicians in the network from major educational centers such as UCLA and UCSF
- Features: Straightforward app-based interface for patients on the go. The app is totally integrated with the patient’s insurer, labs, and pharmacy to streamline care and make it painless and efficient. Has a 97% patient satisfaction rate. Currently only available in the US.
- Why Join: If you want a smaller network with a focus on patient satisfaction, ease of use, and an app-based experience then PlushCare is your choice.
- Size: Unknown but growing
- Features: Open to MDs, DOs, and Nurse Practitioners. It offers telehealth solutions with combined access to a distributed provider network, digital prescriptions, cloud pharmacy, and consumer engagement strategies, all delivered through mobile and Web interfaces. With a particular focus on the thornier areas of men’s and women’s health, this platform is trusted for its discretion. Areas of specialty include Family Medicine, Internal Medicine, Emergency Medicine, Gynecology, Urology, Dermatology, or Psychiatry.
- Why Join: This company recently went public and has a fair amount of brand identity with the millennial crowd. Hims has also been entirely “cash pay,” meaning it doesn’t accept insurance. Members pay a subscription of around $20-30 per month to have 24/7 access to online physician consultation and steady supplies of generic medications. If you want a bit of specialization, a bit of brand identity and a focus on the millennial crowd then Hims and Hers is for you.
If you have your own private practice you can offer telemedicine as a service under your own name or brand.
This model provides more control and allows for a physician-first approach. You control the message and what services you offer. You just use the infrastructure offered by the telemedicine technology provider.
Many of the same telemedicine companies that enroll physicians into their network as independent contractors offer a version of their interface for private practices.
Now that you’ve decided to practice telemedicine the next step is understanding how to get paid for your services.
Besides meeting the basic eligibility requirements the next most important step is understanding the basics of coding and fee schedules. The amount the CMS pays for physician-delivered services are listed in difficult-to-find fee schedules that make it challenging to find a published dollar figure.
There is a good reason most employers don’t want these fees made easily accessible. It’s because they pocket the difference between the CMS allocated Fee and what they pay the telemedicine physicians that are enrolled in their provider network. Margins for telemedicine employers can be upwards of 70%!
To receive the full CMS service fee (instead of just a cut) you’ll need to directly work with CMS and run your own healthcare delivery service. This can be as an owner of a private practice or even a new telemedicine venture but either way, you’re now running a business with full responsibility for end-to-end service and finances.
For now, we’ll focus on what you need to know to get paid while working for a telehealth company or as part of a private practice.
To ensure you can get paid for telemedicine services, 3 requirements must be met:
While reimbursement regulations have been relaxed, medical licensure requirements still may apply at the state level. For example, CMS said providers could now use telehealth across state lines and practice at their highest level of training. However, in some states, like California, they are not allowing out-of-state providers to do this.
Patients may need to consent to this form of care verbally or in writing, and processes need to be in place to capture that consent was obtained. You’ll need to verify the requirements for your state and payers.
Consent has loosened up a bit during the pandemic. CMS says they can give verbal consent at the time of service. It appears that most payers are following suit, but it is good to confirm.
The consent can be given once annually just be sure you have a digital process to do so.
Coding and billing
The rules and regulations around telehealth reimbursement have and will continue to change frequently. Continuing to monitor guidelines and reimbursement updates with each payer.
You can create a spreadsheet to track the requirements for all your payers and document details such as requirements for modifiers, place of service, or documentation. To be safe, document everything!
In response to the coronavirus pandemic, CMS has approved 80 codes to be used with telehealth and non-face-to-face encounters (NFTF).
NFTF codes can be useful when the physician is asked to address patient problems when the patient is not present. NFTF services include telephone calls, online digital E/M services, interprofessional telephone/internet/ electronic health record consultations, digitally stored data services/remote physiologic monitoring, remote reporting of self-measure blood pressure and remote physiologic monitoring treatment management services.
Full list of telehealth services under the Medicare physician fee schedule for the calendar year 2021
Let’s look at the CMS reimbursement levels for the most common telemedicine services in 2021.
Physician or Other Qualified Healthcare Professional.
- G2012: $14.82 for 5 – 10 minutes (verbal/synchronous). Medical discussion to determine if an in-person appointment is required.
- G2010: $12.13 for 5 – 10 minutes (text, images, video / asynchronous). Remote evaluation of recorded video and/or images including interpretation with follow-up with the patient within 24 business hours (i.e. the patient sends their dermatologist a picture of a rash)
Other Non-physician healthcare professionals
- G2251: $14.66 for 5 – 10 minutes (verbal/synchronous). Medical discussion to determine if an in-person appointment is required.
- G2250: $12.21 for 5 – 10 minutes (text, images, video / asynchronous). Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours
These two codes mirror the physician virtual check in codes, G2010 and G2012, that CMS allowed nonphysician practitioners to bill during the public health emergency (PHE).
These are patient-initiated services through the secure platform (such as a patient portal) where there is a secure, electronic evaluation/assessment/management of the patient by the provider.
Online Digital Evaluations by Physicians and qualified healthcare professionals
These are patient-initiated services with physicians or other QHPs. Online digital evaluation and management (E/M) services require physician or other QHP’s evaluation, assessment, and management of the patient.
- 99421 – $15.38 for 5-10 minutes
- 99422 – $30.77 for 11-20 minutes
- 99423 – $49.79 for 21+ minutes
Qualified non-physician healthcare professionals (eg. physical therapists, occupational therapists, speech language pathologists, clinical psychologists):
Online assessment and management- notice the use of the word “assessment” instead of “E/M”. As of January 2021 CMS replaced G2061–G2063 with the three equivalent CPT® codes 98970–98972 moving forward.
- 98970: $12.07 for for 5-10 minutes
- 98971: $21.30 for for 11-20 minutes
- 98972: $33.36 for 21 or more minutes
An encounter between patient and provider traditionally via phone. Note that pre-pandemic these services were not reimbursable by CMS. However, CMS will now cover and pay for both new and established patients during the public health emergency. In fact, CMS now allows almost all telehealth, virtual check-ins, and e-visits to be provided to any patient – new or established.
Physicians and qualified healthcare professionals:
- 99441: $56.88 for 5-10 minutes of medical discussion
- 99442: $92.83 for 11-20 minutes of medical discussion
- 99443: $131.55 for 21-30 minutes of medical discussion
Qualified non-physician healthcare professionals
- 98966: $14.03 for 5-10 minutes of medical discussion
- 98967: $27.26 for 11-20 minutes of medical discussion
- 98968: $40.31 for 21-30 minutes of medical discussion
Remote monitoring of physiologic parameter(s) through medical devices.
- 99453: $19.68 for initial; set-up and patient education on the use of equipment. The code requires 16 days of readings to be recorded during the 30-day billing period.
- 99454: $63.81 for initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days. Requires at least 16 days of device readings submitted by the patient within the 30-day period. Meaning, to receive reimbursement, the physician must have at least 16 days worth of readings from the patient.
- 99457: $51.90 for treatment management services, initial 20 minutes of clinical staff/physician/other qualified healthcare professional time in a calendar month requiring interactive communication with the patient/ caregiver during the month.
- 99458: $41.93 for each additional 20 minutes; frequency limitations apply.
- 99091: $57.99 for minimum 30 mins of collection and interpretation of physiologic data digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional. In this instance, a QHP is qualified by education, training, licensure/regulation (when applicable). The code requires a minimum of 30 minutes of interpretation and review and is billable once in a 30-day billing period.
- Note: The data from devices used in conjunction with 99091 do not have to be from a device as defined by the FDA. There is no set number of conditions that must be monitored to meet criteria related to CPT Code 99091.
- CPT 99091 must be performed by a physician or other qualified health professional. It is not a treatment management service code but rather a data accession, review, interpretation, and modification of care plan code.
- Note that in 2020, CPT codes 99457 and 99091 could not be billed concurrently; however, in 2021, 99091 and 99457 can be billed concurrently for the same patient in the same month if all the requirements for each code are fulfilled.
- Requires no communication between patient and provider
Related: Read our full post on RPM Devices and Reimbursement
Triage or evaluation
- D0140 – Limited oral evaluation – problem-focused
- D0170 – Re-evaluation – limited, problem-focused (established patient; not
- post-operative visit)
- D0171 – Re-evaluation – post-operative office visit
- D9992 – Dental case management – care coordination
- D9995 – Teledentistry – synchronous; real-time encounter
- D9996 – Teledentistry – asynchronous; information stored and forwarded to
- dentist for subsequent review
Virtual Check-Ins – Brief 5-10 minute check-in. Can use Virtual check-in codes G2012 and G2010 for QHP or G2251 and G2250 for non-physician HP.
When a state enacts a telemedicine parity law, private payers in that state are required to reimburse for telemedicine coverage in the same manner as they do with in-person care. As a result, if a new parity rule is implemented, it is a major victory for telemedicine.
Numerous private payers want to cover telemedicine in either case. They are simply not legally obligated to reimburse. 29 states have now enacted parity legislation, with eight new states considering such legislation. Furthermore, because of the cost benefits that telemedicine can provide, commercial payers are becoming increasingly driven to cover it.
Although all states with telehealth parity legislation require payers to cover live video telemedicine, only a few require payers to cover store-and-forward telemedicine. Additionally, some parity statutes have unique limitations and exclusions.
While over 90% of healthcare organizations reported fully meeting the demand for telehealth during the Covid-19 health crisis, only 20% said they would continue telehealth offerings if reimbursement levels were to return to pre-Covid levels. An additional 30% were unsure of what they would do.
What is obvious here is that healthcare leaders lack the tools to decipher their next steps in telemedicine. In the face of this uncertainty, there is a tendency to default back to the way things were.
Many organizations have no idea how their telemedicine services are performing, let alone how to improve them. This is not surprising given how quickly organizations were forced to stand up telemedicine services during the pandemic.
But, this is a dangerous strategy and one that is likely to leave many health organizations at a significant disadvantage in the coming years.
So what are the right metrics to monitor the performance of a telehealth service?
For that, we can look to the e-commerce industry which figured this out a long time ago. The best KPIs provide meaningful and actionable insights to you (or your team).
Here are the 5 critical telehealth metrics that healthcare leaders need to pay attention to in order to ensure that their telehealth services are performing as well as they should:
- Reimbursement by Modality
- Patient Lifetime Value
- Patient Satisfaction/Retention
- Average Reimbursement Level
- Visit Volume by Modality
Here’s why these are the 5 most important telehealth metrics to understand.
The reimbursement rate is, simply put, the percentage of telemedicine services or consultations provided that are reimbursed. In the case of most telemedicine services this rate should be quite high (>75%).
If your chosen telemedicine service focuses on an out-of-pocket patient-paid model then your reimbursement rate may be significantly lower. Either way this metric is critical to understand because it informs the manner in which patients pay for services.
Measuring this across video, email, phone or other modality will tell you which manner of interacting with patients leads to the highest reimbursement success rates.
Another way to approach the reimbursement rate is the number of visitors that take action on the platform or website, divided by the total number of visitors. That action might refer to a signup, inquiry, account creation etc. (between 2%- 3% for standard e-commerce).
However, gaining access to this information means that you’ll need access to the platform traffic data, which you likely won’t have access to unless you run your own telemedicine platform.
In a nutshell, your conversion rate is indicative of how successful all of your business strategies are in getting people to engage with your telemedicine service. Ultimately, it impacts just about every other KPI involved.
Patient lifetime value (PLV) measures the total amount of what you earn from an average patient over their lifetime.
To increase your telemedicine service PLV, you can work on improving your average reimbursement level (more on this later) and engendering loyalty among your existing patients so they become repeat visitors in the future.
While there’s no denying the importance of expanding as a business and reaching new patients, long-term success is often attributed to the ability to maximize customer retention rate.
In practice, having patients come back for more is a sure sign that your telemedicine efforts are not being wasted, especially since repeat patients often refer to new patients.
It’s therefore crucial for care providers to monitor their patient retention rates to see if patients are coming back—and to determine what’s driving them to stay or pushing them to leave. In turn, this will naturally have an effect on attracting new patients.
A Harvard Business School study shows that just a 5% increase in retention can increase profits anywhere from 25% to 95%. Finding ways to get more business out of existing customers is hugely profitable and cost-effective.
If the bulk of your patients come back every year, you can focus on quality care and loyalty. If you have to rebuild your patient base every year, you have an acquisition-driven business.
As the name suggests, your average reimbursement rate refers to the average value of each service you provide through telemedicine.
To calculate yours, simply divide the sum value of all services provided (reimbursable and out-of-pocket) by the number of telemedicine interactions (across all modalities).
Here are a few ways to drive this metric up:
- Offer patients the use of modalities with higher reimbursement rates.
- Focus on time-dependent services with the highest fee/per-unit- time
- Include Asynchronous services that can take place during off-hours or concurrently throughout the day.
- Offer your patients complementary health services that improve the outcomes of their primary health concern (eg. a nutrition plan, a check-in schedule, remote monitoring devices)
Tracking where most of your telemedicine interactions are happening is crucial. Are you mainly interacting by phone? Email? Video?. It’s likely a mix so getting an accurate picture of this distribution will allow you to optimize correctly.
You may also discover that your total volume across all modalities isn’t where it could be. In this case you want to expand the overall funnel of patient traffic.
To grow your telemedicine traffic effectively you can:
- Promote your offerings on social media and local support groups.
- Create a website or landing page and optimize it for search engines.
- Offer a topical newsletter where patients can hear your opinions and reach out to you.
I cover more ways to improve your telemedicine income in the section below.
Want to dive a bit deeper?
As your telemedicine business grows you can add several other metrics. For example, consider adding Patient (Customer) Acquisition Cost as an additional metric. Your CAC tracks the average cost of gaining one customer, including everything from marketing and sales costs to the cost of paying your support staff and hosting a website.
This will give you an overall figure, but you can also calculate your CAC by source (e.g. different traffic channels like search engines, social media, or email list).
To bring down your CAC, you can:
- Improve your conversion rate.
- Optimize your advertising to spend less on every acquired customer.
- Invest in free/organic marketing like SEO and social media marketing.
- Invest in referral marketing to encourage existing customers to bring in new customers.
Although this list of telemedicine metrics is by no means exhaustive, it’s at least a good starting point as you build and grow your telemedicine presence.
As your telemedicine practice grows and secures more patients, your data points will also increase in number, giving you more data to track, measure, and improve.
Ultimately, tracking these metrics will help you make the best decisions for your telemedicine practice.
Remember that volume is key
The best way to make money in telemedicine is to make efficient use of your time. Maintaining a consistent patient volume is critical to your success. Since most telemedicine companies pay per consult, infrequent patients mean you’re sitting idly at your desk without getting paid. Some companies will set a base hourly rate in case patient volume is low. Be sure to ask about volume when exploring telemedicine opportunities.
Get licensed in more states
You’ll be the most valuable and likely to garner the highest pay if you get your medical license in multiple states. The best states to be licensed in are California, New York, Texas, and Florida.
Work across multiple telemedicine platforms
Again, keeping busy with a continual patient flow is going to make the best use of your working hours. Most telehealth companies don’t have non-competes meaning you can sign up with multiple platforms and schedule shifts back-to-back.
Work during high season
Telemedicine follows the same population health trends as a traditional practice. Telemedicine companies often staff up during the fall and winter season and may pay a premium for supplemental part-time help during that time. Consider adding a few telemedicine shifts to your winter work week for some extra income.
Work during off-hours
If you are willing to work nights or weekends, you may be able to garner a higher hourly rate or per-patient compensation. Consider your time zone too. If you are on the West Coast, you could pick up a night shift in New York that wouldn’t keep you up as late.
Set financial goals
Set micro-goals by deciding how much you want to make per month or per week and determining how many shifts you’ll need to make it happen. Is your goal realistic? Working from home requires more self-discipline than traditional practice – this helps to keep yourself accountable.
Take advantage of tax breaks
As an 1099-issued independent contractor, you can write off any expenses related to work. Internet, telephone, even part of your rent or home mortgage.
Send out an email to all of your patients, colleagues, friends, & family- announce your telemedicine launch. Even in today’s social media age, email marketing continues to be one of the most important tools for e-commerce, particularly when it comes to remarketing and generating repeat business.
According to Campaign Monitor, email marketing delivered an ROI of 4400% in 2016 and their 2018 annual report revealed 59% of marketers believe email delivers the highest ROI of all marketing channels.
As you build your email list with contacts from your existing patient base, referrals, direct feedback efforts, personal outreach, and website, you’ll need a way to manage this efficiently. One of the best and easiest ways to apply e-commerce best practices is to use email marketing management software.
I recommend using an email and contact list management software like ConvertKit.
This is what I use for my businesses. It is the best email marketing tool for small-to-medium audiences and is used extensively by small businesses and bloggers.
Start a Newsletter
Unlike ordinary website/page visitors, people who sign up for your newsletter care enough about your brand to get updates on your expertise and services. This means they are also more likely to become patients in the near future.
Create and Distribute materials
Provide materials on the telehealth services you provide in your informed consent packet.
Create a website
Create a website. Boost your SEO! Patients look for providers online now. You need to have an online presence beyond the stock profiles available on the platforms.
I recommend linking your website directly in all your emails. Without a website or at least a landing page, you’ll miss a key opportunity to convey legitimacy and attract patients to your telemedicine services.
Getting a landing page up and running from scratch can be done cheaply in just a few hours. You can get started for just $2.65/month with Bluehost. It’s the fastest way to get your project an online presence for this outreach phase.
Utilize your social media accounts to highlight services you provide using Telemedicine. We’ve seen users utilize Twitter, Facebook, LinkedIn, Google+, Instagram, and more to market that they provide Telemedicine.
Targeted digital ads
Providers can get a surprisingly great ROI from targeted Facebook ads to their Facebook business pages.
Join online databases and groups
Add your name to a database. (Yelp, Goodtherapy.org, healthgrades.com) Encourage patients to leave reviews.
Consider writing a personal piece on your practice and services in Psychology Today or a magazine relevant to your field. Patients love to see and hear their doctors engaging the community, disseminating expertise, and caring for others.
Send out mailers to your current clients. This can be especially useful with the older crowd that may be keener on receiving healthcare information via the mail.
Seek out local referral sources
Connect with your local referral sources, primary care providers, school counselors, and clergy in your community, often clients will seek out these resources before they make it to your office.
Telemedicine allows you to work how you want and where you want. Take advantage of that freedom and spend a little time creating a space that makes you crazy productive, motivated, and inspired to practice medicine your own way.
Whether you are transitioning to full-time telemedicine from a traditional in-office practice or simply adding part-time telehealth services to supplement your salary, you’ll want to consider your home workspace.
Practicing telemedicine from home is relatively simple and requires very little equipment and setup. But it can be exciting to thoughtfully design a space that enables you to practice medicine from the comfort of home. And it’s also a good time to evaluate your old equipment and upgrade if you’ve been eyeing a new computer or office accessories.
The first step in setting up your telehealth home office is to check your equipment. You probably already own everything you need to practice telemedicine. But it’s also a good time to take stock of your devices and use the opportunity to upgrade if you’ve been looking for a good excuse.
Note that you don’t need all the items in this list, but we’ve outlined a few setups and accessories you might consider for your ideal workspace.
Here’s the essential equipment needed for telemedicine
- A reliable internet connection: HD video conferencing requires speeds of at least 5 Mbps for uploading and downloading. Most internet services in the US provide speeds much faster than that. But if you are traveling, you’ll want to check your connection. You can test your internet speed here.
- Laptop with camera and microphone: You can supplement with an external camera and microphone that plugs into your USB port if you have a device without one.
- Desktop monitor with camera and microphone: An additional monitor gives you a bigger screen to work with and can be more comfortable for heavy home office use. Supplemented with an external camera and mic this setup provides exceptionally high-quality video conference capabilities.
- Headset/headphones: Sometimes built-in microphones and computer speakers just don’t cut it. A headset or headphones with an attached mic can be a comfortable and hands-free option for video consults. They also help drown out any background noise that could distract you or your patients.
- External speakers: If you don’t want to wear a headset or headphones, you can supplement with external speakers that plug into your device. This can help if your device volume doesn’t get loud enough.
- External microphone: If patients struggle to hear you or your microphone doesn’t function as it should, you can pick up a cheap external mic that plugs into your USB.
- iPad/tablet or smartphone with a stand: If you’re only performing light telemedicine tasks or need to consult on-the-go, you could probably get by with just a smartphone or tablet and stand. Modern cell phones won’t allow you to easily take notes simultaneously. We recommend using this setup as a backup or supplemental to your main computer.
- Ergonomic external keyboard and mouse: If you spend a long time at the computer, it’s worth investing in an external ergonomic keyboard and mouse. This also helps if you’ll be doing work through a tablet.
- Amwell: Telemedicine equipment from Amwell ranges from telemedicine cards to peripherals. Home kits can be used with a virtual care app to connect patients and providers with data and communication in real-time.
- VSee: VSee offers telemedicine kits for remote consultations, home care kits, and full medicine carts with optional devices including digital stethoscopes.
- InTouch Health: InTouch Health has telemedicine solutions including dedicated tables, TVs, and a wide range of telehealth carts. All InTouch Health carts offer video capabilities.
- AMD Global Medicine: Integrated medical devices from AMD Global Medicine include cameras, scopes, and vital sign monitors.
- GlobalMed: Telemedicine stations from GlobalMed offer virtual care delivery, designed to be used at remote sites, homes, workplaces, schools, and other facilities.
Take the time to design a comfortable and private workspace. A healthy space can improve your telemedicine practice efficiency, enhance the virtual patient experience, and create an ergonomic environment to care for patients most effectively.
Here are some tips for designing a comfortable telemedicine space.
- Quiet, private room with a door: Choose a space that is free of excessive noise that you can close off when needed. Even if you aren’t taking video consults, you’ll want the opportunity to close out the world and get after it.
- Clean white or light-colored background: For video consults, set up your computer’s camera so that it is facing a clean wall or bookshelf without a bright window behind you. Window light behind the camera can cause shadows and make it difficult for the camera to register your face.
- Comfortable desk or table: Setting up a table and chair at the correct height is important to prevent back pain. (Pro-tip: use this calculator to determine your ideal table, chair, and armrest height.)
- Adjustable office chair: Between video calls, documentation, and managing email you’ll spend a significant amount of time in this chair. So take care of yourself first. Invest in a high-quality chair that makes you feel good, confident, and ready to take care of others.
- Natural-colored lighting: No fluorescent bulbs. They are heinous to work under and provide a less-than-flattering hue. Do yourself a favor and install soft-white bulbs in your ceiling lamps. Better yet invest in a customizable lighting setup that allows you to control position and color temperature.
- Greenery and decor: Bring the outside in with some live plants and don’t take for granted the power of a few decorative accents. We spend a lot of time at work, so it’s nice to make a space that truly feels yours.
Telemedicine is here to stay. Understanding the most important factors is the first step to enable a highly successful telemedicine practice. Focusing on telemedicine as an e-commerce business is the most important mindset shift that you can make in 2022.
The rest is execution and of course making some well-informed choices. Luckily, you’re now armed with all the key insights to make those choices.
It can take as little as two weeks to stand up a telemedicine offering, but nailing your strategy and putting in place the right support systems will ensure you generate the highest possible income streams for your telemedicine business.
Now, go and change the world!