Efficient Quality Care

Satchel is designed around the way nurses and clinicians naturally operate every day.

Workflow


Event

Event

A patient event occurs at a facility, prompting the nursing staff to deliver immediate care to a patient.

Triage

Triage

A nurse, in the Satchel platform, enters relevant patient data into a dynamic questionnaire, offering immediate context to the dispatcher and remote clinician.

Dispatch

Dispatch

Using the submitted information, the dispatcher selects the most appropriate clinician for the encounter based on their record, specialty, and availability.

Encounter

Encounter

Once the clinician accepts, they are able to join an encounter with the nurse and the patient. A suite of real-time streaming diagnostic devices offer medical context that ensure delivery of the highest quality of care.

Wrap Up

Wrap Up

Once the encounter is concluded, the dispatcher files the appropriate billing information and the clinician is available for a new consult.

Access and Availability

Access and Availability

Intelligent multi-speciality networks allow Satchel to quickly engage many clinical resources to find the one most suited for the encounter. Satchel can cover facility needs 24/7, all year long, and can connect staff to clinicians within minutes.

Quick Resolution Times

Quick Resolution Times

Satchel provides clinicians with contextual data throughout the encounter, offering intelligent and evidence-based suggestions. Real-time streaming diagnostics create an intimate experience for everyone involved. Fast access to the right information results in efficient encounters and better patient care.

Fewer Readmissions

Fewer Readmissions

Greater medical context and collaboration allow clinicians to care for patients in place, reducing the number of unnecessary ED visits and hospital readmissions. Satchel offers a dynamic experience to efficiently provide the most appropriate and highest quality of care.

Operate Effectively

Greater access to less expensive care provides financial opportunity for each facility.

Reimbursement By State


See what telemedicine reimbursement means in your state, adjusted by various skilled nursing CPT codes.

Reimbursement Likelihood

Average

Average likelihood is an average between the likelihood of consult reimbursement and facility reimbursement.

Consult

Consult likelihood is the probability of reimbursement for the provider participating in the encounter.

Facility

Facility likelihood is the probability of reimbursement for the facility housing the patient.

Skilled Nursing Facility CPT Codes

"Straightforward Complexity"
99307

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Typically, 10 minutes are spent at the bedside and on the patient's facility floor or unit.

"Low Complexity"
99308

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Typically, 15 minutes are spent at the bedside and on the patient's facility floor or unit.

"Medium Complexity"
99309

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Typically, 25 minutes are spent at the bedside and on the patient's facility floor or unit.

"High Complexity"
99310

Subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Typically, 35 minutes are spent at the bedside and on the patient's facility floor or unit.

Citation - American Medical Association (2016). "Code Manager”.

Medicare Reimbursement

Here you can look at medical reimbursement on a state-by-state level either by the likelihood that telemedicine could be carried out in that state or by the size of reimbursement according to CPT code.

Current Procedural Terminology (CPT) is a set of codes maintained by the American Medical Association for the purpose of uniform communication amongst physicians, coders, patients, payers, and administrators when describing medical, surgical, or diagnostic services. See what various codes mean for your state.

For more information on each of the codes, click here.

Alabama

Alabama Medicaid reimburses for live video for the following services:

  • Consults
  • Office or other outpatient visits
  • Individual psychotherapy
  • Psychiatric diagnostic services
  • Neurobehavioral status exams

For all telemedicine services, an appropriately trained staff member or employee familiar with the patient or the treatment plan must be immediately available in person to the patient.

Originating site must be located in Alabama. The distant site may be located outside of Alabama as long as the physician has an Alabama license and is enrolled as an Alabama Medicaid provider.

Sources:
AL Medicaid Management Information System Provider Manual, p. 538 and 773, (Jul. 2015) & AL Admin. Code r. 560-X-6-.14 (2011).

Alaska

Alaska Medicaid will pay for a covered medical service furnished through telemedicine application if the service is:

  • Covered under traditional, non-telemedicine methods
  • Provided by a treating, consulting, presenting or referring provider
  • Appropriate for provision via telemedicine

The department will pay only for professional services for a telemedicine application of service. The department will not pay for the use of technological equipment and systems associated with a telemedicine application to render the service.

Sources:
AK Admin. Code, Title 7, 110.625(a, b) (2012).

Arizona

AHCCCS will reimburse for medically necessary services provided via live video in their fee for service program.

The patient’s primary care provider (PCP), attending physician, other medical professional employed by the PCP, or an attending physician who is familiar with the patient’s condition, must be present.

Sources:
AZ Health Care Cost Containment System, AHCCCS Fee- For-Service Provider Manual, Ch. 10: Professional and Technical Services, p. 38 and 39 (Nov. 2014). (Accessed Jul. 2015).

Arkansas

Arkansas Medicaid will reimburse for up to two visits per patient, per year. A benefit extension request may be approved if it is medically necessary.

Live video services will be reimbursed the same as if the services were provided in-person if conditions in AR Code 17-80-117 such as provision of services provided by an Arkansas licensed or certified healthcare provider, professional relationship and eligible originating site.

  • Eligible Originating Sites
  • In-patient or non-emergency hospital
  • Physician office or clinic
  • Ambulatory surgical center
  • FQHC
  • Emergency department

Sources:
AR Provider Manual, Section II: Physician/Independent Lab/CRNA/Radiation Therapy Center, p. 69 and 132. (Accessed Jul. 2015)
AR Code 23-79-1602.

California

Medi-Cal will reimbursement for services provided via live video.

Medi-Cal will reimburse the originating site a facility fees, and originating and distant site for live video transmission costs.

The type of setting where services are provided is not limited.

Sources:
CA Department of Health Care Services. Medi-Cal Part 2 General Medicine Manual. Telehealth. Pg. 1 and 2. (Dec. 2013), (Accessed Jul. 2015).

Colorado

Colorado Medicaid will reimburse for medical and mental health services. Services shall be subject to reimbursement policies developed by the medical assistance program.

Reimbursement must be the same as in-person services.

The CO Medical Assistance Program will reimburse for transmission costs, at a rate set by their state department.

Sources:
CO Revised Statutes 25.5-5-320 (2012) & CO Medical Assistance Program, Telemedicine Manual, p. 2 (Apr. 2015). (Accessed Jul. 2015)

Connecticut

Connecticut’s Medical Assistance Program will not pay for information or services provided to a client by a provider electronically or over the telephone.

Sources:
CT Provider Manual. Physicians and Psychiatrists. Sec. 17b-262-342. Pg. 9, Aug, 2013 and CT Provider Manual. Psychologists. Sec. 17b-262-472. Pg. 7. (Accessed Jul. 2015).

Delaware

The Delaware Medical Assistance Program will reimburse for "telemedicine-delivered services."

  • Eligible Originating Sites
  • Hospitals
  • Federally qualified health centers (FQHC)
  • Public health clinics
  • Program for All-Inclusive Care for the Elderly (PACE) centers

The originating site will be reimbursed a facility fee for the telemedicine space and equipment.

Sources:
DE Dept. of Health and Social Svcs., Press Release DHSS-59-2012, (Jun. 27, 2012). (Accessed Jul. 2015).

Florida

Reimbursement is available through Florida Medicaid. Only physicians can provide and receive reimbursement for telemedicine services.

A physician, ARNP or PA may initiate a consultation from the spoke site. The referring practitioner must be present during the consultation as well as the recipient. Only certain consultation codes are reimbursed for telemedicine.

Telecommunication with recipient at a location other than the spoke site is not allowed. Telemedicine services are limited to:

  • Hospital outpatient setting
  • Inpatient setting
  • Physician office

Both the hub and spoke sites must be located in Florida.

Sources:
FL Dept. of Health, Practitioner Services Coverage and Limitations Handbook, p.137 (Apr. 2014). (Accessed Jul. 2015).
FL Dept. of Health, Practitioner, Policy and Procedure Handbook, p.137 (Apr. 2014). (Accessed Jul. 2015).
FL Dept. of Health, Specialized Therapeutic Services Coverage and Limitations Handbook, p.9-12 (Mar. 2014)
FL Community Behavioral Health Services Coverage and Limitations Handbook, p. 9-10 (Mar. 2014). (Accessed Jul. 2015).

Georgia

Georgia Medicaid will reimburse for live video when the service is "medically necessary, the procedure is individualized, specific, consistent with symptoms or confirmed diagnosis of an illness or injury under treatment, and not in excess of the member’s needs." Eligible services include:

  • Office visits
  • Pharmacologic management
  • Limited office psychiatric services
  • Limited radiological services
  • A limited number of other physician fee schedule services

Georgia Medicaid will reimburse for mental health services for residents in nursing homes via telemedicine (although not available in all areas of the state) for "dual eligibles" (Medicaid and Medicare). Eligible originating sites include:

  • Provider offices
  • Hospitals
  • Critical Access Hospitals (CAH)
  • Federally Qualified Health Centers (FQHC)
  • Skilled nursing facilities

Originating sites can bill for a facility fee.

Sources:
GA Dept. of Community Health, GA Medicaid
Telemedicine Handbook, p. 2-3, (Oct. 2014). (Accessed Jul. 2015).
GA Dept. of Community Health, Division of Medical Assistance, Part II Policies and Procedures for Nursing Facilities, p. 189 (Jul. 1, 2015) and Part II Policies and Procedures for Community Behavioral Health Rehabilitation Services, p. 61 (Jul. 1, 2015).
GA Dept. of Community Health, GA Medicaid Telemedicine Handbook, p. 3, (Oct. 2014). (Accessed Jul. 2015).

Hawaii

Hawaii Quest will reimburse for live video, as long as it "includes audio and video equipment, permitting real- time consultation among the patient, consulting practitioner and referring practitioner."

Eligible originating sites:

  • Hospitals
  • Critical Access Hospitals
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Federal telehealth demonstration project sites.

In addition, originating sites must be located in one of the following:

  • A federally designated Rural Health Professional Shortage Area
  • A county outside of a Metropolitan Statistical Area
  • An entity that participates in a federal telemedicine demonstration project.

Sources:
Code of HI Rules 17-1737 (2012).

Idaho

Idaho Medicaid will reimburse for a limited number of mental health and developmental disabilities (DD) services.

Telehealth services are only covered for participants who live in a rural HPSA or MSA where there is a shortage of qualified providers. The provider must document when there is no provider available to provide the services in person.

ID Medicaid does reimburse for the transmission fee of the originating and distant site for mental health services.

Sources:
Medicaid Telehealth Policy. Rev. 7/18/2014. (Accessed Jul. 2015).

Illinois

Illinois Medicaid will reimburse for live video under the following conditions:

  • A physician or other licensed health care professional must be present with the patient at all times with the patient at the originating site
  • The originating and distant site provider must not be terminated, suspended or barred from the Department’s medical programs
  • Medical data may be exchanged through a telecommunication system
  • The interactive telecommunication system must, at a minimum, have the capability of allowing the consulting distant site provider to examine the patient sufficiently to allow proper diagnosis of the involved body system. The system must also be capable of transmitting clearly audible heart tones and lung sounds, as well as clear video images of the patient and any diagnostic tools, such as radiographs.

Eligible originating site:

  • Physician office
  • Podiatrist office
  • Local health departments
  • Community mental health centers
  • Outpatient hospitals
  • Rural health clinics
  • Encounter Rate Clinics
  • Federally Qualified Health Centers

There is reimbursement for originating site facility fees.

Originating site providers who receive reimbursement for the patient’s room and board are not eligible for facility fees.

Sources:
IL Admin. Code Title 89, 140.403.
IL Dept. of Healthcare and Family Svcs., Expansion of Telehealth Services, Informational Notice, Jan. 1, 2010. (Accessed Jul. 2015).
IL Handbook for Practitioners Rendering Medical Services, Ch. A-200, Policy and Procedures for Medical Services, p. 38 (Aug. 2010). (Accessed Jul. 2015).

Indiana

No reimbursement for the following:

  • Ambulatory surgical centers
  • Outpatient surgical services
  • Home health agencies or services
  • Radiological services
  • Laboratory services
  • Long-term care facilities, including nursing facilities, intermediate care facilities, or community residential facilities for the developmentally disabled

Telemedicine services may only be offered in an inpatient, outpatient or office setting.

Sources:
IN Admin. Code, Title 405, 5-38-4 (2012) & IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).
IN Medicaid Provider Manual. July 1, 2015. P. 853-863. (Accessed Jul. 2015).

Iowa

Currently no information for telemedicine reimbursement in Iowa.

Kansas

Kansas Medicaid will reimburse for live video, for the following services:

  • Office visits
  • Individual psychotherapy
  • Pharmacological management services

The patient must be present at the originating site.

Sources:
KS Dept. of Health and Environment, Kansas Medical Assistance Program, Provider Manual, General Benefits, p. 26 (Dec. 2014). (Accessed Jul. 2015).

Kentucky

Kentucky Medicaid will reimburse for a "telehealth consultation", which includes live video.

Telehealth is covered to the same extent the service and provider are covered when furnished face-to-face.

Providers must be approved through the Kentucky e- Health Network Board. Must be approved member of KY telehealth network.

Sources:
KY Revised Statutes 205.559 (2012).
KY State Plan Amendment. Attachment 3.1-B. Approved 3/9/2011. (Accessed Jul. 2015).

Louisiana

Louisiana Medicaid reimburses for "services provided via an interactive audio and video telecommunications system."

Louisiana Medicaid only reimburses the distant site provider.

Sources:
LA Register, Volume 31, 2032 (2012).
LA Dept. of Health and Hospitals, Professional Svcs. Provider Manual, Chapter Five of the Medicaid Svcs. Manual, p. 156 (As revised on May 28, 2015). (Accessed Jul. 2015).

Maine

MaineCare will reimburse for live video when there is a compelling benefit for the patient in order for telehealth services to be appropriate and related to physical, social or geographic issues that make delivering the service in person difficult.

Telehealth can substitute for a face-to-face encounter under the Home Health Services program.

Sources:
Code of ME Rules. 10-144-101 & MaineCare Benefits Manual, General Administrative Policies and Procedures, 10-144 Ch. 101, p. 20 (Jan. 1, 2014). (Accessed Jul. 2015).
MaineCare Benefits Manual, Home Health Services, Ch. III, Sec. 40, p. 1 (Jan. 1, 2014), (Accessed Jul. 2015).

Maryland

Reimbursement for telemedicine is required by Maryland Medical Assistance if the health care service is medically necessary and provided:

  • For the treatment of cardiovascular disease or stroke
  • In an emergency department setting
  • When an appropriate specialist is not available

Eligible Distant Site Providers:

  • Free standing renal dialysis centers
  • Federally Qualified Health Centers
  • Hospitals, including EDs
  • Local health departments
  • Nursing facilities
  • Physicians
  • Nurse practitioners
  • Nurse midwives

The originating site may bill for a "tele-presenter" if it is medically necessary.

Distant site provider must be located within the State, the District of Columbia, or a contiguous state.

Originating sites are eligible for:

  • A transaction fee
  • If the originating site is a hospital, the appropriate revenue code
  • If the originating site is an out-of-state hospital, a telemedicine transaction fee

Sources:
MD Insurance Code Sec. 15-105.2
MD Department of Health and Mental Hygiene, Maryland Medicaid 2014 Telemedicine Provider Manual. September 2014, p. 4-6 & Code of Maryland Admin. Regs. Sec. 10.09.49.05-07.
MD Department of Health and Mental Hygiene, Maryland Value Options, Provider Alert. Telemental Health. July 12, 2011 p. 2. (Accessed Jul. 2015).
Code of Maryland Admin. Regs. Sec. 10.09.49.07.

Massachusetts

Currently no information for telemedicine reimbursement in Massachusetts.

Michigan

Michigan Medicaid reimburses for the following services categories via live video:

  • Inpatient Consults
  • Office or other outpatient consults
  • Office or other outpatient services
  • Psychiatric diagnostic procedures
  • Nursing facility subsequent care

The initial visit for nursing facility services must be face-to-face.

Where face-to-face visits are required, telemedicine services may be used in addition to the required face-to- face visit, but cannot be used as a substitute.

Eligible originating sites:

  • County mental health clinics or publicly funded mental health facilities
  • Federally Qualified Health Centers
  • Hospitals (inpatient, outpatient, or Critical Access Hospitals)
  • Physician or other providers’ offices, including medical clinics
  • Hospital-based or CAH-based Renal Dialysis Centers
  • Rural Health Clinics
  • Skilled nursing facilities
  • Tribal Health Centers

Originating site may bill for a facility fee.

Sources:
Dept. of Community Health, Medicaid Provider Manual, p. 1504 and 1505 (Jul. 1, 2015) & MI Department of Community Health Bulletin Telemedicine. Aug. 30, 2013. (Accessed Jul. 2015).
Dept. of Community Health, Medicaid Provider Manual, p. 1504 (Jul. 1, 2015).

Minnesota

Minnesota’s Medical Assistance program reimburses live video for fee-for-service programs.

Prepaid health plans may choose whether to cover telemedicine services.

Telemedicine consults are limited to three per calendar week per patient. Payment is made to both the consulting physician and the referring physician if the referring physician is present during the consult.

The patient record must include a written opinion from the consulting physician. Telemedicine consults shall be paid at the same rate as in-person services.

Sources:
MN Dept. of Human Svcs., Provider Manual, Physician and Professional Services, As revised Jan. 13, 2015. (Accessed Jul. 2015).
MN Statute Sec. 256B.0625

Mississippi

There is live video reimbursement for Medicaid mental health medication evaluation and management.

Sources:
Code of MS Rules 23-206, Rule. 1.9, pg. 28.

Missouri

HealthNet will reimburse for live video for medically necessary services.

Telehealth services are limited to:

  • Consultation made to confirm a diagnosis
  • Evaluation and management services
  • A diagnosis, therapeutic or interpretive service
  • Individual psychiatric or substance abuse assessment diagnostic interview examinations
  • Individual psychotherapy

Reimbursement to the provider at the distant site is made at the same amount as for an in-person service.

Originating sites are eligible to receive a facility fee; distant sites are not eligible. The cost of an optional telepresenter is included in the facility fee.

Sources:
MO Revised Statutes § 208.670 (2012)
MO HealthNet, Provider Manual, Behavioral Services, Section 13, p. 54 (Oct. 23, 2013) & Physician Services, Section 13, p. 121 (Apr. 14, 2014). (Accessed Jul. 2015).
MO Code of State Regulation, Title 13, 70-3.190 (2010).
MO HealthNet, Community Psychiatric Rehabilitation Program Manual, Sec. 13, pg. 178 (Apr. 2, 2015). (Accessed Jul. 2015).
MO Code of State Regulations, Title 13, 70 3.190 (May 31, 2011) & Physician Services, Section 13, p. 121 (Apr. 14, 2014). (Accessed Jul. 2015).

Montana

Montana Medicaid will reimburse for live video services when the consulting provider is enrolled in Medicaid.

The requesting provider need not be enrolled in Medicaid nor be present during the telemedicine consult.

The place of service is considered to be the location of the provider providing the telemedicine service.

Sources:
MT Dept. of Public Health and Human Svcs., Medicaid and Medical Assistance Programs Manual, Physician Related Svcs., p 25 and 54 (Jul. 2014). (Accessed Jul. 2015).

Nebraska

For managed care plans who contract with the Department, in-person contact is not required for reimbursable services only to the extent that:

  • Services delivered via telehealth are covered and reimbursed under the fee-for-service program
  • Managed care contracts are amended to add coverage of services delivered via telehealth

Reimbursement shall, at a minimum, be set at the same rate as a comparable in-person consult and the rate must not depend on the distance between the health care practitioner and the patient.

Telehealth services are not covered if the patient has access to a comparable service within 30 miles of his/her place of residence.

Exceptions to this requirement:

  • Emergency or urgent medical situations
  • When accessing in-person services at less than 30 miles poses a significant hardship on the patient, due to a medical condition or disability
  • Nursing facility patients who require transportation via ambulance.
  • Recently Passed Legislation: Children receiving behavioral health services.

Medicaid coverage of transmission costs is available.

Sources:
NE Revised Statutes Sec. 71-8506 (2012).
NE Admin. Code Title 471, Ch. 1.
Physician Provider Handbook, Manual Letter 63-2014 Source (Children’s behavioral health): LB 556 (Recently passed, effective Aug. 30, 2013).
LB 556 (Recently passed, effective Aug. 30, 2013)
Code Title 471, Ch. 1 & Physician Provider Handbook, Manual Letter 63-2014.

Nevada

Nevada Medicaid will reimburse for live video. Eligible services:

  • Consultations
  • Follow-up inpatient consults
  • Office of other outpatient visits
  • Subsequent hospital care services
  • Subsequent nursing facility care services
  • Individual psychotherapy
  • Pharmacologic management

Reimbursement should be at the same amount as in-person services.

Subsequent nursing facility care is limited to one telehealth visit every 30 calendar days.

Eligible originating sites include:

  • Office of a physician, physician assistant, nurse practitioner, or nurse, midwife
  • Critical Access Hospital (CAH)
  • Rural Health Clinic (RHC)
  • Federally Qualified Health Center (FQHC)
  • Hospital
  • Hospital-based or CAH-based renal dialysis center (including satellites)
  • Skilled nursing facility
  • Office of clinical psychologist
  • Office of clinical social worker
  • Community mental health centers
  • Indian Health Services, tribal organization, or urban

Sources:
NV Dept. of Health and Human Svcs., Medicaid Services Manual, Section 3403.3, p. 4-6 (Nov. 14, 2014).

New Hampshire

Limited reimbursement for some live video services. NH Medicaid follows the reimbursement policies of Medicare.

NH Medicaid follows Medicare telehealth reimbursement policies. Telehealth services may only be provided to NH Medicaid enrollees who are in a rural health professional shortage area or a county not in a Metropolitan Statistical Area.

Additionally, only certain health facilities may serve as an originating site.

Sources:
NH Bill SB 112 (2015).

New Jersey

Telepsychiatry may be utilized by mental health clinics and/or hospital providers of outpatient mental health services to meet their physician related requirements including but not limited to intake evaluations, periodic psychiatric evaluations, medication management and/or psychotherapy sessions for clients of any age.

Before any telepsychiatry services can be provided, each participating program must establish related policies and procedures.

Sources:
NJ Division of Medical Assistance and Health Services. Newsletter. Vol. 23, No. 21, December 2013.

New Mexico

New Mexico Medicaid will reimburse for live video at the same rate as when the services are furnished without the use of a telecommunication system.

Telemedicine is also covered by NM Managed Care.

An interactive telehealth communication system must include both interactive audio and video, and be delivered on a real-time basis at both the originating and distant sites.

The originating site can be any medically warranted site.

Reimbursement is made to the originating site for an interactive telehealth system fee at the lesser of the following:

  • Provider's billed charge
  • Maximum allowed by MAD for the specific service or procedure.
  • A telemedicine originating-site communication fee is also covered if the eligible recipient was present at and participated in the telemedicine visit at the originating site.

Sources:
NM Medical Assistance Division Managed Care Policy Manual. Aug. 15, 2014.
NM Administrative Code 8.310.2.

New York

Reimbursement policy applies to fee-for-service. Managed care plans may cover telemedicine at their own option and establish their own payment guidelines and structure.

Transmission fee may be billed under certain circumstances.

Sources:
NY Dept. of Health, Medicaid Update, Vol. 31, Number 3, March 2015, p. 18 and 21.

North Carolina

North Carolina Medicaid will reimburse for live video medical services and tele-psychiatry services.

All services must be:

  • Medically necessary
  • The procedure, product, or service is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the recipient’s needs
  • The procedure, product, or service can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide
  • The procedure, product, or service is furnished in a manner not primarily intended for the convenience of the recipient, the recipient’s caretaker, or the provider

Providers must obtain prior approval from NC Medicaid for all services delivered via telemedicine and tele- psychiatry. Providers must submit:

  • Prior approval request
  • All health records and any other records to document that the patient has met the specific criteria for telemedicine services
  • If the patient is under age 21, information supporting that all Medicaid (EPSDT) criteria are met, and evidence-based literature supporting the request, if available

Sources:
NC Div. of Medical Assistance, Medicaid and Health Choice Manual, Clinical Coverage Policy No: 1H, Telemedicine and Telepsychiatry, p. 3-6, Nov. 15, 2013.

North Dakota

North Dakota Medicaid will reimburse for live video services as long as the patient is present during the service. Actual visual contact (face-to-face) must be maintained between practitioner and patient.

Both originating-site and distant-site physicians may bill for services. There is no separate reimbursement for supplies.

Requires a medical professional, such as a nurse, to be present during the telehealth service; and to ensure a connection has been established with the distant physician.

Out of state requests for telemedicine services require prior authorization.

The distant site must be a sufficient distance from the originating site to provide services to patients who do not have readily available access to such specialized services allowed/reimbursed by ND Medicaid via telemedicine.

Reimbursement will be made to the originating site as a facility fee only in place of service office, inpatient hospital, outpatient hospital, or skilled nursing facility/nursing facility. There is no additional reimbursement for equipment, technicians or other technology or personnel utilized in the performance of the telemedicine service.

Sources:
ND Dept. of Human Svcs., General Information For Providers, Medicaid and Other Medical Assistance Programs, p. 129 (April 2012).
Medicaid Medical Policy. North Dakota Department of Human Services: Policy Number NDMP-2012-0007. Telemedicine Services. (Jan. 14, 2015).

Ohio

Ohio Medicaid covers live video telemedicine. Only resident modifiers will be accepted.

Providers are not eligible for payment when a Q3014 (facility fee) and a CPT code with a GQ modifier is submitted for the same patient, same date of service, and same provider.

Originating site eligible for a facility fee using HCPCS code Q3014. See transmittal letter for additional billing rules.

Sources:
OH Medicaid Handbook Transmittal Letter No. 3334-15- 01, pg. 5-7. Jan. 2, 2015 & OH Admin Code 5160-1.

Oklahoma

SoonerCare (Oklahoma’s Medicaid program) reimburses for live video if the health care provider determines the service to be appropriately provided via telemedicine. This applies to health care service plans, disability insurer programs, workers’ compensation programs or state Medicaid managed care program contracts.

Coverage is limited to rural or geographic areas where there is a lack of local medical/psychiatric/mental health expertise.

Rural areas are defined as counties with fewer than 50,000 people.

An appropriate certified or licensed health care professional at the originating site is required to present the member to the distant site and remain available as clinically appropriate.

Facility fee paid to originating site.

Sources:
OK Admin. Code Sec. 317:30-3-27.
Health Care Authority, Providers, Telemedicine (accessed Jan. 15, 2015).
OK Admin. Code Sec. 317:30-3-27(c) (5) & Oklahoma Health Care Authority, Providers, Telemedicine (accessed Jan. 15, 2015).
Health Care Authority, Providers, Telemedicine

Oregon

Oregon Medicaid will reimburse for live video when billed services comply with their billing requirements.

The referring provider is not required to be present with the client for the consult.

The referring provider may bill for the patient visit only if a separately identifiable visit is performed.

Oregon Medicaid will provide transmission fees for originating sites.

Sources:
OR Div. of Medical Assistance Program, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 68-69 (Mar. 10, 2015).
OR Admin. Regulation 410-130-0610(5) & OR Div. of Medical Assistance Programs, Medical-Surgical Svcs. Rulebook, Div. 130, 410-130-0610, p. 69 (Mar. 10, 2015).

Pennsylvania

Pennsylvania Medicaid will reimburse for live video for specialty consultations.

Originating site may bill for facility fee.

Sources:
PA Department of Public Welfare, Medical Assistance Bulletin 09-12-31, 31-12-31, 33-12-30, May 23, 2012.
PA Department of Public Health, Medical Assistance Bulletin OMHSAS-14-01, Mar. 18, 2014.

Rhode Island

Currently no information for telemedicine reimbursement in Rhode Island.

South Carolina

South Carolina Medicaid will reimburse for live telemedicine and tele-psychiatry.

Eligible services:

  • Office or other outpatient visits
  • Inpatient consultation
  • Individual psychotherapy
  • Pharmacologic management
  • Psychiatric diagnostic interview examination and testing
  • Neurobehavioral status examination
  • Electrocardiogram interpretation and report only

Eligible services must meet these requirements:

  • The medical care is individualized, specific, and consistent with symptoms or confirmed diagnosis of the illness or injury under treatment, and not in excess of the beneficiary’s need
  • The medical care can be safely furnished, and no equally effective and more conservative or less costly treatment is available statewide.

There must be a certified or licensed health care professional at the referring site to present and remain available as clinically appropriate.

Eligible originating (referring) sites:

  • Practitioner offices
  • Hospitals (inpatient and outpatient)
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Community mental health centers

Distant (consultant) sites must be located in the SC Medical Service Area, which is the state of SC and areas in NC and GA within 25 miles of the SC border.

The referring site is eligible to receive a facility fee.

Sources:
SC Health and Human Svcs. Dept. Physicians Provider Manual, p. 184-187 (Jul. 1, 2015).

South Dakota

South Dakota Medicaid will reimburse for the following services at the same rate as in-person services:

  • Patient office consultation
  • Inpatient hospital consultation
  • Pharmacologic management
  • Office or other outpatient visit
  • Diabetes outpatient self-management education services

All telemedicine services must comply with South Dakota Medicaid’s Out-Of-State Prior Authorization Requirements.

An originating site may not be located in the same community as the distant site. Originating sites approved for a facility fee include:

  • Office of a physician or practitioner
  • Outpatient hospital
  • Critical Access Hospital
  • Rural Health Clinic
  • Federally Qualified Health Center
  • Indian Health Services Clinic
  • Community Mental Health Center

Originating sites are eligible for a facility fee.

Sources:
SD Medical Assistance Program, Professional Svcs. Manual, p. 27-28 (Jul. 2015).
SD Administrative Rules 46:20:32:08.

Tennessee

TennCare will reimburse for live video for crisis-related services.

Sources:
TN Dept. of Mental Health and Substance Abuse Svcs., p. 4, (July 2012).

Texas

Texas Medicaid reimburses for live video. Eligible originating sites:

  • Established medical site
  • State mental health facility
  • State supported living facility

Telehealth eligible originating site presenter:

  • An individual who is licensed or certified in Texas to perform health care services
  • A qualified mental health professional

A telepresenter is required at the originating site for both telemedicine and telehealth, unless the services relate to mental health. In that situation a patient-site presenter does not have to be readily available unless the client is in a danger to himself/herself or others.

More than one medically necessary telemedicine or telehealth service may be reimbursed for the same date and same place of service if the services are billed by providers of different specialties.

Provider reimbursement must be the same as in-person services. Telemedicine patient site locations are reimbursed a facility fee.

Sources:
TX Admin. Code, Title 1, Sec. 354.1432 & TX Govt. Code Sec. 531.0216.
TX Medicaid Telecommunication Services Handbook. P. 4-8 (Jul. 2015).
TX Admin. Code, Title 1 Sec. 355.7001 & TX Medicaid Telecommunication Services Handbook, pg. 6 (Jul. 2015)

Utah

Utah Medicaid covers medically necessary physician and nurse practitioner services delivered via telemedicine.

Must comply with Utah Health Information Network Standards for Telehealth, which includes billing standards.

There is reimbursement in the UT Medicaid Telehealth Skilled Nurse Pilot Project for Patients in Rural Areas. Patient eligibility requirements:

  • Reside in underserved rural areas
  • Require two or more home care nursing visits per week
  • Be eligible for Medicaid coverage
  • Require medical monitoring for diabetes
  • Be willing and able to use required technology

Sources:
Utah Medicaid Provider Manual. Section I. General Information (Jul. 2015), pg. 13-14.
Utah Medicaid Provider Manual: Home Health Agencies, p. 18-20 (Jul. 2015).

Vermont

Live video is reimbursed.

Originating site providers are required to document the reason the service is being provided by telemedicine rather than in person.

Reimbursement allowed, but not required, for originating site providers.

Sources:
Dept. of VT Health Access, Provider Manual, p. 109-119 (Jul. 13, 2015).

Virginia

Reimbursement for all Medicaid recipients irrespective of fee-for- service or managed care organization coverage.

Providers must by physically present in Virginia during the telemedicine encounter.

Reimburses a facility fee.

Sources:
VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Physician/Practitioner Manual, Covered Svcs. and Limitations, p. 25 (Apr. 2, 2012).
VA Dept. of Medical Assistant Svcs., Medicaid Provider Manual, Psychiatric Services Provider Manual, Covered Svcs. and Limitations, p. 36 (Dec. 30, 2013).

Washington

Reimbursement for patients with fee-for-service coverage.

Patients must be present and participate in the visit.

For patients with managed care plan coverage, telehealth services will not be reimbursed separately. All services must be arranged and provided by primary care providers. It is not mandatory that the plan pay for telehealth services.

Facility fees for originating sites, except inpatient hospitals.

Sources:
WA State Health Care Authority, Medicaid Provider Guide, Physician-Related Svcs./Health Care Professional Svcs., p. 64-65 (Jul. 1, 2015).

West Virginia

West Virginia Medicaid reimburses for live video consultations for medical services and nutrition and exercise services. Those requirements are:

  • The consult must involve real-time consultation as appropriate for the member‘s medical needs, and as needed to provide information to and at the direction of the consulting physician
  • Coverage of consult is limited to members in non-metropolitan statistical professional shortage areas as defined by the Centers for Medicare & Medicaid Services. The referring provider must be located in the same non- metropolitan area
  • The referring provider may bill for an office, outpatient, or inpatient evaluation and management (E&M) service that precedes the consultation, and for other Medicaid-covered services the consultant orders, or for services unrelated to the medical problem for which the consult was requested. However, the referring provider may not bill for a second visit for activities provided during the consult
  • The consultant must be in control of the member‘s medical examination, with the referring provider participating, as needed. The patient must be present in real time, and telecommunication technology must allow the consultant to conduct a medical exam
  • The consultant must provide the referring physician with a written report
  • Separate payment is not made for the review and interpretation of medical records
  • Coverage is limited to professional consultations that meet the criteria

Limited to members in CMS-defined non-metropolitan statistical professional shortage areas. The referring provider must be located in the non-metropolitan area.

Sources:
WV Dept. of Health and Human Svcs., Medicaid Provider Manual, Chapter–519 Covered Svcs., Limitations, And Exclusions For Practitioner Svcs. – Including Physicians, Physician Assistants, And Advanced Registered Nurse Practitioners, p. 25 (Jan. 16, 2012).

Wisconsin

Forward Health will reimburse for medical and mental/behavioral health services via live video.

Reimbursement is subject to the same restrictions as in-person services.

Only one eligible provider may be reimbursed per member per date of service (DOS), unless it is medically necessary for the participation of more than one provider.

Separate services provided by separate specialists for the same patient at different times on the same date may be reimbursed separately.

Out-of-state providers, except border-status providers, must obtain prior authorization (PA) before delivering services to Wisconsin Medicaid members.

Reimbursement for originating site facility fees. Eligible originating sites:

  • Physician offices
  • Hospitals (inpatient or outpatient, excluding emergency rooms)
  • Any other appropriate place of service with necessary equipment and staffing

Sources:
WI Forward Health, Covered and non-covered services, Physician, (accessed Jul. 22, 2015).

Wyoming

Reimbursement is made for exams performed via a real- time interactive audio and video telecommunications system. The patient must be able to see and interact with the off-site practitioner during the exam. A medical professional is not required to be present with the client at the originating site unless medically indicated.

Eligible originating sites:

  • Hospitals
  • Physician or practitioner offices (includes medical clinics)
    • Psychologists or neuropsychologists offices
    • Community mental health or substance abuse treatment centers (CMHC/SATC)
    • Advanced practice nurses with specialty of psychiatry/mental health offices
    • Office of a Licensed Mental Health Professional
    • Federally Qualified Health Centers
    • Rural Health Clinics
    • Skilled nursing facilities
    • Indian Health Services Clinics
    • Hospital-based or Critical Access Hospital- based renal dialysis centers (including satellites)
    • Development Center

A medical professional is not required to be present at the originating site, unless medically indicated.

Each site is able to bill their own services as long as they are an enrolled Medicaid provider (includes out-of-state Medicaid providers).

Reimbursement for originating site fees. No reimbursement for transmission fees.

Sources:
WY Dept. of Public Health Insurance, Medicaid, General Provider Information, p. 108-111 (Jun. 29, 2015).

Reduce Readmissions

With limited access to medical expertise, many post-acute care facilities experience excessive hospital readmissions. Providing effective care in place eliminates financial penalties, offers reimbursable opportunities and most importantly, manages the health of the patient in an optimal manner.

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Data-driven confidence offers post-acute care management the opportunity to participate in innovative payment models. Organizations that deploy the Satchel platform can benefit from participation in the value-based care system. The access to quality care at a lower cost equates to financial success.

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The Satchel solution does not require any clinical commitment. Organizations have the opportunity to utilize their own clinician networks, the Satchel clinician network, or a combination of the two. The Satchel dispatching system will operate based on the preferences of each facility in order to provide constant access to medical expertise.

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Our team is comprised of experts in live video, audio, and data streaming using WebRTC technology.

Clinical Context

Using the Satchel technology, a clinician can hear a heartbeat from a thousand miles away or view vital signs in real-time over a secure channel. Satchel includes clinical options such as a stethoscope, pulse oximeter, EKG, and dermatoscope. “Extending clinical potential” means empowering a clinician to have unlimited ability to treat a patient from anywhere.

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Satchel is intelligent, but it can also become more accurate with more information. Satchel can assist a clinician in dynamic workflows, based on data and medical history. The more often the system is used, the smarter this technology becomes, providing an increasingly helpful process.

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Intelligent business metrics are critical for the performance of any organization. Satchel provides a variety of real-time information related to all aspects of the Satchel workflow. Whether it’s information about clinician performance, facility operations, or platform usage, Satchel’s analytics have it covered.

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Security is Our Priority

We take patient data and network security very seriously at Satchel Health. Data security is our top priority at Satchel Health. Our platform has end-to-end encryption, ensuring the secure transmission of patient information.

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100% HIPAA-compliant

The Satchel platform is engineered from the ground up to ensure 100% HIPAA compliance. Our system goes beyond what is required to protect sensitive patient data.

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Simply Scalable

Whether there are ten encounters in a day or ten thousand, our solution is designed for optimal performance. Satchel’s platform always guarantees high-resolution and quick connection.

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