To date, there are 33 states plus the District of Columbia, that have parity laws that require private payer reimbursement for telemedicine services. All states with parity laws require private payers to pay for video-conferencing. To date, only a few states require reimbursement for store and forward telemedicine. Organizations should also understand that payment for telemedicine services may not equal that of onsite services.
Although the Patient Protection and Affordable Care Act of 2010 governs telemedicine in certain situations under Medicare, telemedicine regulation for the most part falls to the states. As of spring 2018, 49 states and Washington, D.C., provide reimbursement via Medicaid for some version of live video care, according to the Center for Connected Health Policy, a group that promotes telemedicine.

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Projections for the growth of the telehealth market are optimistic, and much of this optimism is predicated upon the increasing demand for remote medical care. According to a recent survey, nearly three-quarters of U.S. consumers say they would use telehealth.[44] At present, several major companies along with a bevvy of startups are working to develop a leading presence in the field.
In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren't licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions.

Today, 95 percent of Americans own cell phones and 77 percent own smartphones. These and other mobile devices can be leveraged to promote better health outcomes and increased access to care. mHealth or mobile health refers to healthcare applications and programs patients use on their smartphones, tablets, or laptops. These applications allow patients to track health measurements, set medication and appointment reminders, and share information with clinicians. Users can access hundreds of mHealth applications including asthma and diabetes management tools as well as weight loss or smoking cessation apps. Additionally, mobile devices allow users to schedule appointments and communicate with providers via video conference and text message.
The Health Resources Services Administration defines telehealth as the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.

In Australia, during January 2014, Melbourne tech startup Small World Social collaborated with the Australian Breastfeeding Association to create the first hands-free breastfeeding Google Glass application for new mothers.[23] The application, named Google Glass Breastfeeding app trial, allows mothers to nurse their baby while viewing instructions about common breastfeeding issues (latching on, posture etc.) or call a lactation consultant via a secure Google Hangout,[24] who can view the issue through the mother's Google Glass camera.[25] The trial was successfully concluded in Melbourne in April 2014, and 100% of participants were breastfeeding confidently.[26][27] Small World Social[28] Breasfteeding Support Project.[29]


The development of modern telemedicine began with the invention of the telecommunications infrastructure, including the telephone and telegraph. Early on, telemedicine technology was adopted for use in military situations during the Civil War, such as ordering medical supplies or medical consultations. Casualty and injury lists were also delivered via telegraph.
Telehealth includes such technologies as telephones, facsimile machines, electronic mail systems, and remote patient monitoring devices, which are used to collect and transmit patient data for monitoring and interpretation. While they do not meet the Medicaid definition of telemedicine they are often considered under the broad umbrella of telehealth services. Even though such technologies are not considered "telemedicine," they may nevertheless be covered and reimbursed as part of a Medicaid coverable service, such as laboratory service, x-ray service or physician services (under section 1905(a) of the Social Security Act).
Telemedicine is viewed as a cost-effective alternative to the more traditional face-to-face way of providing medical care (e.g., face-to-face consultations or examinations between provider and patient). As such, states have the option/flexibility to determine whether (or not) to cover telemedicine; what types of telemedicine to cover; where in the state it can be covered; how it is provided/covered; what types of telemedicine practitioners/providers may be covered/reimbursed, as long as such practitioners/providers are "recognized" and qualified according to Medicaid statute/regulation; and how much to reimburse for telemedicine services, as long as such payments do not exceed Federal Upper Limits.
Up until 2013, hospitals were required to staff their EDs with a physician 24 hours a day, either on site or on call. In 2013, the Centers for Medicare & Medicaid Services adjusted that requirement to allow rural hospitals to use advanced practice providers, such as a physician assistants and nurse practitioners, as long as physicians could be summoned via telemedicine in an emergency.
In the last decade, rapid advances in medicine and technology has resulted in the use of new terms. Policymakers, healthcare systems, advocacy groups, and vendors may unknowingly use terms incorrectly when discussing medicine and technology. This is especially true when it comes to the terms, telemedicine and telehealth. Although the words are often used interchangeably, there is certainly a difference between the two.

Online medical care might not be the doctors and nurses of your parents’ time, but it is a huge advancement that will help care for your parents’ future. Geriatric care is greatly impacted by the mobility of older patients and using technology-based doctor appointments is a much-needed solution. So, is this new-fangled approach to healthcare here to stay? It sure looks that way!


A sexually transmitted illness, which affects men and women of all ages, herpes is embarrassing to deal with. Whether in the form of a cold sore on your mouth, or a rash on your genitals, discomfort and unease is sure to follow. While there is no cure for Herpes at this time, there are several treatment options which have been made available across the United States.

With approximately 30-million cases of thyroid conditions across the U.S., including some 15-million which are undiagnosed, the need for fast and efficient prescriptions in this area is high. Women have a higher chance of contracting disorders of the thyroid, but they can affect men as well. Symptoms include anxiety, chronic fatigue syndrome, numbed senses of smell and taste, lowered sex drive, dry skin, stomach pain, digestive issues, high blood pressure, pain in the joints and muscles, heart palpitations, weight gain, hair loss, and uncontrollable body temperature.
With telemedicine, a medical practice or hospital system can immediately expand access to niche medical specialists. This makes it easy for primary care doctors to consult medical specialists on a patient case, and for patients to see a needed specialist on a rare form of cancer, no matter their location. As another example, small hospitals without adequate radiology specialist on-staff can outsource evaluation of x-rays via telemedicine.
In many states, current regulations require that any provider and patient doing a telemedicine visit have a pre-existing relationship. Usually this means that the provider and patient need to have had at least one in-person visit. This regulation is slowly changing as more companies like Teladoc and DoctoronDemand seek to connect patients with a random, on-call doctor for immediate care.
Type of telehealth. Medicare primarily only reimburses for live telemedicine, where the physician and patient are interacting in real-time through secure, videochat. This type of telemedicine visit is meant to substitute a face-to-face in-person visit. The only exception is in Hawaii and Alaska, where Medicare reimburses for store-and-forward telemedicine as well.
Telehealth Reimbursement Medicaid: According to Chiron Health, Medicaid systems in 48 states will reimburse for telehealth provided via live video systems while 19 state Medicaid programs will pay for RPM. 12 state programs will finance store and forward telehealth and seven states allow payment for all three telehealth categories. But even though Medicaid is more accommodating of telehealth than Medicare, rules governing payment through state Medicaid programs vary considerably. For instance, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to be co-located with patients while they are receiving telehealth services.
Since the internet and mobile devices now pervade our lives, it is natural that people want to leverage telehealth technologies to improve care, offer convenience, promote access, and support sustainability. Telehealth services range from consultations and video conference mental health sessions to public health broadcast text messaging and on-demand provider education.
A radiologist specializes in using medical imaging techniques to both diagnose and treat disease. Their day-to-day responsibilities include working with other healthcare professionals, which can be extremely time-consuming. With telemedicine, radiologists can receive high-quality images and provide feedback on where ever they are. They no longer have to be in the same area as the provider sending over the images, which allows for a more streamlined process.
Equipping nursing homes and hospital rooms this way would enable a variety of practitioners to provide bedside care more conveniently—for the patient and the provider. Patients wouldn't have to be transported, and practitioners could see more patients without disruption. In addition, the primary care provider, family, and friends located elsewhere could link into the video consultations, enhancing communication between all parties involved in the patient's care.
Telehealth allows the patient to be monitored between physician office visits which can improve patient health. Telehealth also allows patients to access expertise which is not available in their local area. This remote patient monitoring ability enables patients to stay at home longer and helps avoid unnecessary hospital time. In the long-term, this could potentially result in less burdening of the healthcare system and consumption of resources.[1][8]

Informed consent is another issue – should the patient give informed consent to receive online care before it starts? Or will it be implied if it is care that can only practically be given over distance? When telehealth includes the possibility for technical problems such as transmission errors or security breaches or storage which impact on ability to communicate, it may be wise to obtain informed consent in person first, as well as having backup options for when technical issues occur. In person, a patient can see who is involved in their care (namely themselves and their clinician in a consult), but online there will be other involved such as the technology providers, therefore consent may need to involve disclosure of anyone involved in the transmission of the information and the security that will keep their information private, and any legal malpractice cases may need to involve all of those involved as opposed to what would usually just be the practitioner.[22][42][43]
Without proper medication, asthma and other respiratory related illnesses can be extremely serious. Chronic asthma affects more than 20-million citizens across the United States, and can appear in early childhood or adolescence. The symptoms vary from person to person, with most individuals experiencing shortness of breath, tightening of the chest, coughing, and wheezing.
For purposes of Medicaid, telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient, and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
Wyoming Medicaid conducted a study measuring engagement and post-birth outcomes for patients  who used a mobile health app called, “Due Date Plus.” Use of the app, which allowed women to record pregnancy milestones, access medical services, and find symptom-related information was associated with increased compliance with prenatal care and decreased occurrence of babies born with low birth weights.
“Formally defined, telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status,” the ATA writes. “Telemedicine includes a growing variety of applications and services using two-way video, e-mail, smart phones, wireless tools and other forms of telecommunications technology.”
After laying out the basics, an organization should decide what type of telemedicine solutions to offer. A telemedicine expert like VSee offers a text and video collaboration app, a Virtual waiting room, and more. The organization should be responding to their current pain points, such as overcrowded waiting rooms or difficulty reaching patients in rural areas.
“Telemedicine is not a separate medical specialty,” the organization continues. “Products and services related to telemedicine are often part of a larger investment by healthcare institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. ATA has historically considered telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare. Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth.”
Doctor On Demand is one of the best-funded Bay Area digital health companies. The region's top digital health startups pulled in $1.5 billion in 2016. As health care continues finding customers outside hospital walls, the industry has seen even brick-and-mortar providers investing in the tech. Fifty million Americans are now willing to switch doctors if given a video visit option, according to a recent trends report.
ISDN Primary Rate Interface (PRI): An ISDN interface standard which operates using one 64K data channel and 23, 64K channels. When the right multiplexing equipment is used, the user can selected the IDN PRI channels for a video call. As an example, if a user would like to have his videoconference at 384K bandwidth, the multiplexer can be instructed to utilize channels 1-6 (6 x 64k= 384k). It is actually quite importance since usually the user pays charges that are based on how many 64k channels get used on a videoconference. So the fewer channels that have to be used to get a quality video signal, the lower the cost of the call will be.
ISDN Basic Rate Interface (BRI): A type of ISDN interface that provides 128K of bandwith tht is used for videoconferencing as well as simultaneous data and voice services. A multiplexer can be used to link together multiple BRI lines in order for higher bandwidth levels to be achieved. For example, one popular option among telehealth networks is combining 3 BRI lines in order for video-conferencing to be provided with 384K of bandwidth. BRI services are unavailable in some rural areas. Before videoconferencing equipment is order for using this kind of service, one needs to check with their telecommunications provider to see if BRI services are available.
Telemedicine can be beneficial to patients in isolated communities and remote regions, who can receive care from doctors or specialists far away without the patient having to travel to visit them.[4] Recent developments in mobile collaboration technology can allow healthcare professionals in multiple locations to share information and discuss patient issues as if they were in the same place.[5] Remote patient monitoring through mobile technology can reduce the need for outpatient visits and enable remote prescription verification and drug administration oversight, potentially significantly reducing the overall cost of medical care.[6] Telemedicine can also facilitate medical education by allowing workers to observe experts in their fields and share best practices more easily.[7]
"Not every holiday party is going to be Pinterest-perfect — and, more importantly, that's completely OK." @DrJohnMayer, a Clinical Psychologist at @drondemand, shares tips on staying happy this holiday season with @EliteDaily.https://www.elitedaily.com/p/how-to-get-along-with-family-during-the-holidays-because-it-is-possible-according-to-experts-13220182 …
A company’s culture is defined by the behavior that is allowed. The Board, CEO and the management team need to set the example—allowing toxic, demoralizing, untrustworthy actions to persist is implicitly endorsing that behavior. Look to the past for what’s likely to come—every leader in the company has brought former colleagues to work alongside them at DOD except for one. Red flag. This leader burns bridges. Act before...
Soon after Alexander Graham Bell patented the telephone in 1876, ideas of using a telephone to communicate with physicians started appearing in the medical literature. However, telemedicine was truly born in the 1950s, when radiologic images were successfully transferred by telephone between West Chester and Philadelphia, Pennsylvania. In the late 1960s and 1970s, telemedicine developed with support from National Aeronautics and Space Administration (NASA), U.S. Public Health Service, Department of Defense and other federal agencies.
Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc.) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline.[3] It does not require the presence of both parties at the same time.[1] Dermatology (cf: teledermatology), radiology, and pathology are common specialties that are conducive to asynchronous telemedicine. A properly structured medical record preferably in electronic form should be a component of this transfer. A key difference between traditional in-person patient meetings and telemedicine encounters is the omission of an actual physical examination and history. The 'store-and-forward' process requires the clinician to rely on a history report and audio/video information in lieu of a physical examination.
With the recent news that Amazon’s Jeff Bezos, Berkshire Hathaway’s Warren Buffet, and J.P. Morgan Chase’s Jamie Dimon have teamed up to disrupt healthcare, it’s easy to speculate that telehealth technology will be a key strategy in efforts to bring down costs. Other employers are seeking to bring down prices as well with the help of telehealth. According to the Society for Human Resource Management (SHRM), not only are employers encouraging the use of telehealth services, their employees, many of whom are digital natives, are quite comfortable using these services. Because of remote healthcare’s lower costs and increased worker productivity and satisfaction, organizations will likely seek telehealth solutions. Moreover, payers, like employers, may be lured by decreased medical expenditures and consumers may be motivated by the convenience and promptness of care that it offers.

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Policies and regulations in the telemedicine arena can be confusing for providers, vendors, and payers. Organizations interested in implementing telemedicine should be familiar with the laws in their state. For example, some states require informed consent from patients, while others do not. Some payers may not pay the same rate for telemedicine services as they do for in-person services. Practices should identify how providers will be paid, as some organizations seek grant funding.
There are the typical discussions about balance between expanding vs. deepening what we currently do. Fair arguments on both sides of the discussion. The company tends to be conservative. Unclear decision making can lead to confusion across the company. Some decisions are made by corporate leaders who don't understand the day to day realties. Needs of the company have outgrown some functional leaders. These issues are...
Today's high-speed broadband based Internet enables the use of new technologies for teleradiology: the image reviewer can now have access to distant servers in order to view an exam. Therefore, they do not need particular workstations to view the images; a standard personal computer (PC) and digital subscriber line (DSL) connection is enough to reach keosys central server. No particular software is necessary on the PC and the images can be reached from wherever in the world.

$49/visit or co-pay if not fully covered by health plan LiveHealth Online powered by AmericanWell / Vidyo has been picked up by health insurer WellPoint / Anthem. First piloted in 2013 in California and Ohio. WellPoint / Anthem began a mass rollout to several states in 2014 including Minnesota, Virginia, Kentucky, Maine…and most recently, Massachusetts.
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