Virtual First Care Coalition IMPACT Releases Payment and Coding Toolkit

New Resource Outlines Virtual Care Reimbursement and Billing Practice Information for Providers and Payers 

BOSTON, Sept. 6, 2023 /PRNewswire/ -- Today, IMPACT, a pre-competitive consortium dedicated to understanding, supporting, and implementing virtual first care (V1C), released the Payment & Coding Toolkit, a new free resource to assist payers and providers as they navigate the payment and reimbursement landscape for V1C services. IMPACT is a collaboration led by the Digital Medicine Society (DiMe) and the American Telemedicine Society (ATA), and is the leading organization and professional home of V1C.

The evolving digital medicine landscape and rise of V1C have changed how patients interact with the healthcare system. V1C offers synchronous and asynchronous interactions between clinical teams and patients, leverages biometric and other sensor technologies to share real-time data across all members of the care team, personalizes approaches to optimize every patient's care journey, and embraces an interdisciplinary approach that includes specialists to provide comprehensive and long-term care. Today, IMPACT's V1C Directory, launched in January, contains over 250 companies that are committed to a virtual-first approach to healthcare.

Even with this progress and promise, traditional coding and reimbursement practices have been designed for in-person visits conducted by qualified health plans (QHPs), leading to gaps in how V1C providers should be reimbursed for their services. Because of these gaps, V1C has the potential to be limited to only individuals who can self-pay, resulting in a lack of care for those who could benefit from these services and creating barriers to success, and even shutdowns, for innovative digital health companies.

"Despite V1C emerging as an essential part of our ecosystem, providers across our community continue to struggle to get reimbursed through the US' traditional, third-party model. This requires immediate attention to ensure these services are available for all patients who can benefit from them," said Jennifer Goldsack, CEO of DiMe. "The current reimbursement framework does not fully meet the needs of the V1C community or the patients they care for, but it includes codes that V1C providers can leverage to get paid. Our new toolkit will help V1C providers navigate the current reimbursement landscape as an interim strategy for financial viability. This is a first step while we work with the industry to ensure that payment policies and models continue to evolve to support V1C as a critical component of healthcare in the digital era, expanding access, improving outcomes, and load balancing across strained brick-and mortar systems".

"Virtual first services have the potential to enhance and extend the care that patients are receiving in clinics and hospitals across the country, but a key barrier to realizing this is ensuring that innovative virtual organizations and providers are set up to understand and navigate the coding and payment landscape," said Dr. Joe Kvedar, the Immediate Past Chair of the Board at the American Telemedicine Association (ATA). "Access to tailored, relevant, up-to-date information can be a game changer for those navigating this complex and evolving arena, breaking down roadblocks to making virtual care easier for health professionals to offer and patients to receive."

The IMPACT Payment & Coding Toolkit includes:

• The IMPACT Coding Library - a comprehensive and interactive coding library that will show users how new or existing care model components might qualify for reimbursement within the existing coding framework. The library will be regularly updated to align with the changing reimbursement landscapes and provides the tools V1C providers need to adhere to the most recent billing and coding standards. 
• The IMPACT Payment & Coding Quickstart Guide - can be used as an internal training document by anyone to learn the basics of billing and coding, the differences between CPT, HCPCS, and ICD-10 codes, code modifiers, and how they all apply within the virtual first care ecosystem.
• IMPACT Payment Vignettes - to illustrate best practices for payment and coding as shared by leading V1C providers. The payment vignettes demonstrate complex coding practices and provide users with tangible examples of various care delivery models that may apply to their organization for more specific guidance on best practices. 

This new toolkit is just one of the influential resources IMPACT has recently launched to drive high-quality V1C. The IMPACT Payer-V1C Contracting Toolkit supports alignment between V1C and payers, and the IMPACT V1C Core Competencies framework shows what good V1C looks like.

If you're interested in joining other top V1C companies to pave the way for a new standard of excellence in healthcare delivery, become an IMPACT member today. Share your interest here.

About IMPACT: Hosted by the Digital Medicine Society (DiMe) and the American Telemedicine Association (ATA), vIrtual first Medical PrActice CollaboraTion ("IMPACT") is a pre-competitive collaboration of leading digital health companies, investors, payors, and consultants dedicated to supporting virtual-first medical organizations and their commitment to patient-centric care. To become a member, visit impact.dimesociety.org to learn more and inquire today.

About the Digital Medicine Society: DiMe is a global non-profit and the professional home for all members of the digital medicine community. Together, we tackle the toughest digital medicine challenges, develop clinical-quality resources on a technology timeline, and deliver these actionable resources to the field via open-source channels and educational programs.

Media Contact: Carla English, [email protected]

SOURCE Digital Medicine Society (DiMe)