Financial – School-based Telehealth

Financial - School-based Telehealth

Highlights:This section is focused on the overall financial issues related to school-based telehealth.

There are some ways to obtain a positive return on investment for school-based telehealth. Reimbursement for school-based telehealth is widespread and growing. But focusing solely on one type of reimbursement can result in missed significant opportunities.

Cost Reduction: Cost Reduction: school-based telehealth solves many logistical barriers to accessing care. In some cases, school-based telehealth reduces costs by:

  • Reducing or eliminating provider travel costs
  • Leveling labor distribution across a network
  • Reducing readmissions
  • Directing patients to an appropriate level of care, for example reducing non-emergent use of the emergency department

Revenue Options: There are many options or combinations of options that have been used to fund school-based telehealth services. Each of the following is in use to varying degrees by different organizations:

Health Insurance Reimbursement – Medicaid and third-party health insurances pay for school-based telehealth services in different degrees. Telehealth reimbursement is now mandated in a growing number of states for third-party health insurance. It is important to check with each health insurance provider individually prior to providing service to verify submission details.

Reimbursement can be available on both ends of the connection. The Professional fee is charged by the provider at the Distant site. A Site Fee can sometimes be charged by the Originating site, especially if a school or school-based health center is prepared to bill Medicaid. Look for code Q3014 in your billing guide.

Federal Grant Funding – HRSA and other Federal agencies have historically funded school-based telehealth to increase access to care in rural areas or to address growing issues such as the opioid epidemic and focus on social determinants of health.

Local Funding – Some state and county health organizations contract with school-based telehealth networks to provide services through Medicaid block grant funds or other operational funds. In addition, foundations at the local level often provide full or partial grants to fund or supplement the funding of school-based healthcare to reach under-served populations.

How much does it cost?
There is no single answer for this, as many variables will impact the answer, depending on the program design and goals.

Budget areas to consider:
Equipment, clinical staffing, administrative staffing, marketing, electronic health records, billing, consumable supplies, CLIA waived test kits

No program will be successful without marketing. Implementation of a school-based telehealth program can be daunting in part because you are changing
1)the PLACE where care is received from the clinic to the school and
2)the modality of care from in-person to telehealth. This requires quite a bit of explaining

Parties to consider in Marketing Plans: students, faculty, parents, employers, general community, primary care providers, care coordinators or case managers, social service agencies

Information Relevant to Financial Reimbursement