Telemedicine has long been established as a cost effective alternative to traditional in-person delivery of healthcare services. While telemedicine has been around for decades, the technology found itself thrust into the spotlight with the coronavirus pandemic.
Prior to 2019, the number of Americans who had used telemedicine services at least once stood at mere 14 percent. Since the pandemic, the number of people who have participated in at least one telemedicine visit has increased to 57 percent.
As more and more private practices, hospitals and healthcare organizations are making the move towards telemedicine adoption, understanding the current telemedicine requirements and regulations applicable when integrating telemedicine becomes of critical importance.
Ensuring Compliance to Telemedicine Requirements
Telemedicine offers compelling benefits for both patients as well as providers. However, one common question that persists in the mind of healthcare professionals when starting up with telemedicine is what regulations do they need to comply with and what requirements need to be followed in order to ensure compliance.
With the COVID-19 pandemic, there have been a number of relaxations in telemedicine requirements at the federal as well as state level, however, as the regulatory scenario continues to evolve, staying up to date with the regulations can help you avoid hefty penalties that arise as a result of non compliance.
Here’s a comprehensive guide you need to understand telemedicine requirements and ensure regulatory compliance when starting out with telemedicine.
1. Regulatory requirements for telemedicine
The guidelines for telemedicine vary on a state-to-state basis. Certain states require pre-existing patient-provider relationships in order to provide virtual consultations. Similarly, some states require explicit written content from patients while some don’t. Even the licensure and practice requirements for healthcare providers vary per state.
In response to the Coronavirus pandemic, a number of states have also issued waivers for telemedicine requirements including issuing of emergency licenses to out-of-state physicians and cross-state licensing, coverage of telemedicine under insurance without a pre-established provider-patient relationship, expanding existing telehealth coverage, ePrescription of medications over telemedicine etc.
The federation of state medical boards has compiled a list of regulatory changes that have been implemented at the state-level since the pandemic began. Depending on the state(s) you are planning to offer telemedicine services in, you would need to check the state-specific requirements and ensure that you comply with the same before you can offer telemedicine services there.
These state-run regulatory boards must operate in accordance with federal telehealth regulations and rules from the Centers for Medicare and Medicaid Services (CMS) governing reimbursement for federal programs.
In addition to the state specific requirements, telemedicine providers also have to comply with laws such as Health Insurance Portability and Accountability Act (HIPAA) and Health Information Technology for Economic and Clinical Health (HITECH) Act.
However, in light of the pandemic, the regulatory agencies have reassessed the existing telehealth rules and introduced waivers. In March 2020, the Health and Human Services Department (HHS) Office for Civil Rights issued a Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 pandemic. This allows the healthcare providers flexibility in adherence to HIPAA during this public health crisis and ensures that the patients get continued access to care.
While the waivers are still in place, if you are planning to get a telemedicine application developed for your practice, working with a development partner who specializes in telemedicine app development and is mindful of the HIPAA requirements goes a long way in safeguarding the privacy and security of protected health information under the HIPAA Privacy, Security and Breach Notification Rules.
2. Infrastructure requirements for telemedicine
Telemedicine implementation for your practice mandates robust hardware, software and network requirements. By having the right infrastructure in place, giving the technical training to the staff for conducting virtual consultations and troubleshooting if/when the need arises, and having the right protocols in place, healthcare practitioners can ensure success at implementing telemedicine within their practice.
- Hardware and software requirements : In order to be successful at telemedicine implementation, accessibility is the key. Developing a mobile telemedicine app makes it feasible for both patients and providers to have virtual health consultations on the go.
- Network requirements : If you are planning to offer video consultations as a part of your telehealth offering, uninterrupted streaming with no buffering is a must for facilitating a productive remote consultation session. The network connection at both provider as well as patient end need to be fast enough for conducive virtual sessions.
- Technical support and training : Technical problems need to be resolved as soon as they arrive. 24×7 tech support and staff training can help address issues as soon as they crop up. Training can also help the not so tech-savvy users, both patients as well as healthcare providers, to get the hang of telemedicine technology and reap the benefits it offers.
- Wearables and Remote Patient Monitoring : Medical devices that collect data regarding patient vitals and securely transmit it over to the healthcare professionals are opening up new frontiers in healthcare delivery through telemedicine. Connected medical devices need to be on your radar when looking to further data-driven healthcare delivery to improve health outcomes.
3. Clinical guidelines for telemedicine
In general, telemedicine consultations need to follow the same standards of practice as regular in-person visits. However, there are state-specific guidelines for practicing telemedicine across the United States. Here are some points that you need to consider when starting with telemedicine.
- Licensure : Most states require the healthcare practitioner to be licensed with the state medical board where they are planning to offer telemedicine services. Some states allow practitioners who aren’t physically present in the state to offer telemedicine services under certain conditions while others don’t. It is always a good idea to check the licensing requirements of each state you are planning to practice in before starting out on telemedicine.
- Pre-established provider-patient relationship : Some states allow for patient-provider relationship to be established via telehealth technology while others require pre-existing in-person relationship with the patient before virtual consultations can be given. While this requirement has mostly been waived off in the wake of the pandemic, it is always beneficial to check out the specific requirements in advance. Some states also require the patients to be given informed consent prior to offering telemedicine services.
- ePrescribing : Prescribing of medications through telemedicine is under a lot of scrutiny and most states have strict guidelines when it comes to ePrescribing. The telehealth standards in relation to ePrescription of medications also varies on a state-to-state basis. Some states do not allow for certain categories of medications to be prescribed through telemedicine necessitating in-person visits in such cases.
- Telemedicine reimbursement : In March 2020, CMS expanded telehealth with the 1135 waiver under which Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence. Both Medicare and Medicaid are increasingly covering telemedicine visits and facilitating reimbursement.
Medicare also covers Virtual Check-Ins, i.e. short patient-initiated communications with a healthcare practitioner. Medicare Part B separately pays clinicians for E-visits, which are non-face-to-face patient-initiated communications through an online patient portal.
The list of which CPT and HCPCS codes are eligible for Medicare reimbursement when providing care through telemedicine keeps updating on a yearly basis. The CMS website has the up-to-date collection of codes that are covered and should be checked out before starting out with telemedicine.
Future of telemedicine
The state as well as the federal governments are increasingly recognizing the importance of telemedicine and working towards overcoming the administrative barriers and making telehealth accessible to all.
With the explosion of patient demand for virtual care, the number of telemedicine-related legislations currently on the table is at an all-time high. As more and more telemedicine companies continue to enter the market and an increasingly large number of practitioners start getting telemedicine platforms developed for their practice, the future of telemedicine is going to be bright.
If you too are starting out your journey into telemedicine, teaming up with the right partners can get you the head start you need to succeed. With more than a decade of specialized experience in the field of healthcare software development, Arkenea is a trusted name in the field of telemedicine. Get in touch with our expert consultants to discuss your custom requirements today.