5 Golden Rules of Telemedicine
As payers and technology continue to develop in support of the rising trend of telemedicine, it is important for providers to understand the basic rules of practicing in the virtual world. Below are five guidelines for healthcare providers offering video visits.
Provider Licensing
Licensure is often seen as one of the biggest barriers to the establishment or growth of a telemedicine program. Despite technology’s ability to connect patients and providers almost anywhere in the world, it is not always legal to do so. When practicing telemedicine, it is critical for providers to remember that they are only permitted to see patients in the states in which they are licensed to practice. This means when your patient is doing a cross-country road trip, you can not conduct a visit with them via video call as a provider. Legislation is currently transforming how licensing is conducted on a state-by-state level, but as of now, providers can not practice across state lines where they are not licensed. You can find more information pertaining to your state by visiting: http://www.americantelemed.org/policy/state-policy-resource-center#.V4Ujt5ODGko
Prescribing Medication
According to Title 21 Code of Federal Regulations, when prescribing medication to patients over a video visit there must be “a legitimate medical purpose in the usual course of professional practice to prescribe.” This means that the doctor must have conducted at least one medical evaluation prior to writing the prescription. Some states do not allow the first interaction where this evaluation would occur to be a virtual one, while others have embraced telemedicine. To be safe, providers that are implementing a video visit solution should only prescribe to patients they already have an existing relationship with. Powerful narcotics have been a major point of contention when it comes to telemedicine and it is recommended that they should only be prescribed under physician supervision. Discretion should be shown when attempting to prescribe these types of pharmaceuticals over telemedicine.
Billing
Billing is a shifting landscape when it comes to telemedicine. Over half of the states now enforce parity law, which requires private insurers to reimburse video visits just as they would in-person visits. However, it does not require them to pay at the same rate. For example, Empire Blue Cross Blue Shield reimburses video visits at half of the rate as an in-person visit. As long as the visit is done over a synchronous audio and video channel, providers typically use the same CPT code for billing as they would with an in-person visit. Some insurers may require modifiers to the code to identify it as a telemedicine visit, but they cannot by law decline a claim on the premise of it being done via telemedicine. Every region has a telehealth resource center, which is an excellent tool for providers looking to get specific questions answered related to Medicaid. This resource center is also good for providers who are curious about their state regulations for billing and utilizing telemedicine in a reimbursable manor. The center closest to you can be found at http://www.telehealthresourcecenter.org/.
Patient Consent
It is important for patients to understand that telemedicine visits are a supplement to treatment, and can be used as a means to improve access to care that may be limited by location or a provider’s time. It is recommended that patients are given the option to choose telemedicine in their care if they think it will fulfill their needs. Telemedicine is a great option for patients who want to forgo the hassles of an in person visit while still receiving a continued quality of care.
Eligible Technologies
The Omnibus Rule of 2013 went a long way in defining what exactly qualifies as a business associate and what is HIPAA compliant when it comes to telemedicine. Under this provision, a telecommunications conduit is any software that uses end-to-encryption, does not store sessions on their servers, and lacks the ability to decrypt live sessions. This means, contrary to popular belief, programs such as Skype, FaceTime, and Google Hangouts may all be used for patient communications without those companies signing a Business Associates Agreement (BAA), similar to how Verizon can facilitate phone calls to patients without becoming a business associate.
By understanding these guidelines, providers are taking the first steps to be prepared to offer HIPAA compliant video visits.
