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Discussion Response

Discussion Response

Sample Answer 

Discussion Response


Thank you for sharing your post. I would like to add a little more on Medi-Cal and telehealth. The State of California’s Department of Health Care Services (DHCS) considers telehealth as an alternative that is cost-effective to health care and which is offered in-person and more so to underserved areas. According to Marcoux & Vogenberg (2016), telehealth is not a service that is distinct but rather a way for providers to deliver health care to patients, which approximates care given in in-person. The care standards are similar to when a person is seen in person or via telehealth. The policies on reimbursement and coverage by DHCS for telehealth are aligned with the California Telehealth Advancement Act of 2011 as well as the federal regulations. The telehealth flexibilities by DHCS are available to providers during the public health emergency (PHE) COVID-19. These federal flexibilities are expected to expire at the PHE DHCS 2020. For Medi-Cal providers that are enrolled, the DHCS policies are applicable. One such policy involves telephonic communication, where brief communications with a patient or another practitioner who, in this case of COVID-19, should and cannot be present physically. Medi-Cal providers are reimbursed using the G2010 and G2012 Healthcare Common Procedure Coding System (HCPCS) codes for brief virtual communications for every service. The telephonic visit should meet the requirements of the HCPCS or CPT codes and, more specifically, the specific conditions. The telehealth policy offers providers flexibility in using telehealth as a modality for delivering medically necessary services for their patients. Details that are program-specific on DHCS policy to telehealth are available in the Highlights of Medi-Cal’s Provider Manuals Highlights and include CPT-4 Code 99451, which may be used in e-consults under the store auspice and forward; no limitations on distant sites or origination; Medi-Cal providers can determine if a specific benefit or service is clinically appropriate via two-way real-time audio-visual communication.


DHCS (2020). Medi-Cal and Telehealth.’%20Medi%2DCal%20telehealth%20policy,Health%20Centers%2FRural%20Health%20Clinics

Marcoux, R. M., & Vogenberg, F. R. (2016). Telehealth: Applications From a Legal and Regulatory Perspective. P & T : a peer-reviewed journal for formulary management, 41(9), 567–570.


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Discussion Response

In the state of California, seeking reimbursement for telemedicine or telehealth is critical for the regulatory initiatives for providers. “Telehealth—the remote delivery of health care to a patient through technology—is becoming mainstream in the US as economic and resource constraints continue to impact the current method of health care delivery and reimbursement models move toward performance-based outcomes and metrics” (Marcoux & Vogenberg, 2016). The federal programs in California vary when it comes to coverage of telemedicine. There are insurance policies such as Medicare that cover specific services. Insurance companies and programs try to promote efficient and quality care to their clients but based on the “umbrella” of telemedicine services within the organization, the rules may vary. Ever since COVID-19 hit, there were many changes made regarding reimbursement policies for telehealth. In California, Medi-Cal for example, allows the provider to decide what services can be used and will be covered, as long as the guidelines of the insurance group is met. This could mean that the provider could decide if a telephone appointment is better for the patient, versus a video. This really depends on the condition and status of the patient. The provider is responsible for deciding if a telehealth appointment is clinically appropriate for the patient. Medi-Cal also covers e-visit appointments which is done via email or online portals, but authorization is required.

Discussion Response

Discussion Response

Marcoux, R. M., & Vogenberg, F. R. (2016). Telehealth: Applications From a Legal and Regulatory Perspective. P & T : a peer-reviewed journal for formulary management, 41(9), 567–570.

Initial Discussion Prompt

How do U.S. government reimbursement policies for healthcare providers impact the use of telemedicine in your state?

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