Winter 2019 From the President’s Desk

Telemedicine:  Are You Ready?

We live in a digital age and what we have always seen and done in healthcare is changing with that. Are we as legal nurses ready to evaluate the changes that will accompany the advancement of telemedicine? It has been estimated that 80% of physicians use smartphones or medical apps in their practice.  Annually, 15 million Americans are already receiving remote care. Kaiser Permanente, one of the Nation’s largest healthcare systems, provides more virtual visits annually than it does in-person.  The American Bar Association lists some issues to be aware of regarding Telemedicine:

Practitioners:

• Are they licensed in every state where the patients are receiving service?
• Does your state have practitioner patient relationship standards prior to engaging in telehealth/telemedicine?
• Are there practice standards set forth by your state licensing boards that practitioners must abide by for treating and prescribing via telehealth and telemedicine?
• Are the practitioners appropriately credentialed and meeting the organization’s requirements/bylaws for engaging in telehealth and telemedicine services?

Payors-Medicare, Medicaid, and Commercial Insurance:

• Are the telehealth or telemedicine services covered by CMS, your state’s Medicaid agency or commercial insurers? If so, what do these agencies or entities specifically require?
• Do Medicare Advantage plans or Medicaid Managed Care Organizations allow coverage of telehealth or telemedicine services?
• What is the reimbursement level for telehealth and telemedicine services?

Fraud and Abuse:

• Is the provider in compliance with the federal Anti-Kickback Statute, the federal Civil Monetary Penalties Law, and the Stark Law?
• Is the provider violating state fraud and abuse or insurance laws?
• Is the provider complying with your state’s corporate practice of medicine rules?
• Is the provider violating fee-splitting laws?

Other Issues 

• Has your state enacted telehealth or telemedicine parity laws?
• Are patient consent and freedom of choice issues for telehealth and telemedicine services implicated?
• Are the telehealth and telemedicine services provided being properly coded and documented?
• Is the provider in danger of violating DEA rules and regulations for prescribing via telemedicine?
• Is the provider in compliance with HIPAA and the associated privacy and security requirements?

Telemedicine is here to stay and as the technology grows, physicians, nurses, and the industry must grow with it, and most importantly, be aware of regulatory implications.

Patricia Mitchell, RN, BSN, CLNC
President, Greater Orlando Chapter of AALNC