The Difference in Practice Expense Costs Between Telehealth and In-Office Care Could Serve as the Basis for Differential Reimbursement Structures

Telemed J E Health. 2021 Oct 8. doi: 10.1089/tmj.2021.0229. Online ahead of print.

ABSTRACT

Background: There has been much recent discussion about the reimbursement of telehealth virtual visits. Advocates argue strongly for payment parity with in-person encounters, whereas payers insist that telehealth visits should be reimbursed at a lower value. Methods: Using the Resource-Based Relative Value Scale structure as a guideline (where physician compensation is divided into categories: time/medical decision making/malpractice expense and practice expense), we developed a framework to examine the difference in practice expense of an in-person practice compared with a scaled virtual practice. Results: We found that for current procedural terminology (CPT) code 99213, the total relative value unit (RVU) for a virtual visit would be 1.62. The in-office RVU for CPT code 99213 is 2.09. This difference could serve as the basis for a rational discussion on differential reimbursement for virtual visits.

PMID:34637679 | DOI:10.1089/tmj.2021.0229