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 many 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: 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
  • Triaging emergency room patients and routing patients to a more appropriate level of care

In an ACO environment, the use of a midlevel provider in a school setting reduces costs greatly by avoiding 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, Medicare, and third-party health insurances all pay for school-based telehealth services in different degrees. HRSA has a handy tool called the Medicare Telehealth Payment Eligibility Analyzer. 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.

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 – Many 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 serve under-served populations.

Here are some additional financial and insurance reimbursement resources for school-based telehealth.

Information Relevant to Financial Reimbursement