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Pay Per View: The Arizona Telemedicine Program's Billing Results

Pay Per View: The Arizona Telemedicine Program's Billing Results

Abstract

This paper describes the results of a study of telemedicine billing and collection activities of the Arizona Telemedicine Program. The program began billing for clinical services in January 1999, one and one-half years after commencement of clinical services. In preparation, a letter was sent to all third-party payers in the state informing them of our intention to bill starting in January 1999. From January 1999–June 2000, 1135 nonradiology cases have been billed. An analysis of the telemedicine billing and collection activities revealed that 47 individual plans were invoiced. The payer mix was Private Insurance 29%, Medicaid/State Programs 24%, Indian Health Service 17%, Medicare/Champus 13%, Self Pay 9%, and Department of Corrections 8%. To date, a total of $41,258 was billed to private payers. Of this, $17,607 was collected, which represents a 42.7% gross collection rate (GCR.) This compares with the university's physician group practice GCR of 48.3%. In the following fiscal year, 1999–2000, the GCR increased to 48.2%. Due to the severe billing limitations imposed by the Health Care Finance Administration (now Centers for Medicare and Medicaid Services), only four Medicare cases were billed during this period. Initially, the State Medicaid program paid for only authorized cases, but has since approved a full-service telemedicine contract. We concluded after a start-up period, billing for telemedicine services parallels a traditional practice when looking at the aggregate GCR. However, there are some differences concerning the types of services billed.
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