Navigating regulations is nothing new to physicians and other providers, but adding telemedicine capabilities to your practice will add a few new compliance concerns. From federal requirements at the Centers for Medicare & Medicaid Services (CMS) and privacy concerns under HIPAA to various state regulations and Medicaid requirements, you will need to devote some resources to properly planning and training.
Here’s a round-up of the key compliance topics you’ll face when delivering telemedicine and telehealth services to your patients.
Keeping Up With Medicare, As Medicare Keeps Up
If you serve Medicare beneficiaries, you will need to check CMS regulations and requirements relating to telehealth.
Although the list is still rather limited, CMS does increase its Medicare-eligible telemedicine treatments each year. For a complete list of currently covered services, check out this useful guide from CMS on CY 2017 services. Here are a few highlights of what is covered:
- Inpatient and hospital services
- Psychotherapy and behavioral counseling
- Kidney and end-stage renal disease
- Substance abuse counseling
- Behavioral counseling
- Advance care planning
- Primary care and well-visits
- Critical care consultations
In the July 2017 proposed changes to the Medicare Physician Fee Schedule for Calendar Year 2018, however, CMS proposes to add the following codes to the list of covered telehealth services:
- HCPCS code G0296 (visit to determine low dose computed tomography (LDCT) eligibility)
- CPT code 90785 (Interactive Complexity)
- CPT codes 96160 and 96161 (Health Risk Assessment)
- HCPCS code G0506 (Care Planning for Chronic Care Management)
- CPT codes 90839 and 90840 (Psychotherapy for Crisis)
The agency also said it would like to eliminate the required reporting of the telehealth modifier for professional claims, citing a goal of reducing administrative burdens for providers. CMS said it is “seeking comment on ways to further expand access to telehealth services within our current statutory authority.”
Medicare tightly regulates where practitioners can provide services and where patients can receive services. Patients must receive services at an approved originating site and practitioners must be located at an approved distant site. Here’s the lowdown on what those terms mean:
Originating Site: This is the patient’s location. Originating sites must be outside of a Metropolitan Statistical Area (MSA) or in a rural Health Professional Shortage Area (HPSA). Not sure whether your site qualifies? Don’t worry—HRSA defines these areas and provides a Medicare Telehealth Payment Eligibility Analyzer that helps determine eligibility.
Within those approved areas, patients must also be in one of the following locations when receiving services:
- The offices of physicians or practitioners
- Critical access hospitals (CAHs)
- Rural health clinics
- Federally qualified health centers
- Hospital-based or CAH-based renal dialysis centers (including satellites)
- Skilled nursing facilities (SNFs)
- Community mental health centers (CMHCs)
Distant Site: This is the provider’s location. While the locations themselves are less prescribed than the originating sites, the eligible providers allowed to furnish services are:
- Nurse practitioners (NPs)
- Physician assistants (PAs)
- Clinical nurse specialists (CNSs)
- Certified registered nurse anesthetists
- Clinical psychologists (CPs) and clinical social workers (CSWs)
- Registered dietitians or nutrition professionals.
More Telemedicine Regulations
Telemedicine and telehealth services fall under several regulatory frameworks overseen by CMS. Be sure you check rules and regulations under all of the following:
Live Reimbursement Only: Unless you’re practicing at an approved site in Hawaii or Alaska, Medicare will only reimburse for live telemedicine services.
Double Reimbursement: Originating sites that host patients can claim a “facility fee” reimbursement from Medicare. Even if you don’t provide any services, make sure you bill Medicare for your facility fee.
GT Modifier: When billing Medicare, make sure to use the “GT” modifier on all your codes. This signifies that these were telemedicine services.
Changing Medicare Rates: Each year, Medicare updates its rates and its eligible services. Use CMS’s Fee-for-Service Payment Tool or its previously mentioned List of Services to find the current services and rates.
Since Medicaid is state-run, telehealth policies vary across all 50 states and Washington, D.C. To find out more about Medicaid in your state, visit the Center for Connected Health Policy’s (CCHP) Telehealth Medicaid & State Policy website. Here are just a few highlights from that report:
- 48 states and D.C. reimburse for live video services
- 13 states reimburse for store and forward services
- 22 states cover remote patient monitoring
- 31 cover a facility fee or transmission fee
To find out more about your state’s Medicaid program, visit Medicaid’s Telemedicine website.
Telemedicine compliance under the Health Insurance Portability and Accountability Act (HIPAA) involves more than a secure connection and safe data transfers. All providers must be aware of HIPAA regulations for all telehealth technologies and services. And service platforms must be explicitly HIPAA-compliant, too.
Exact regulations for HIPAA compliance are dependent on the specific technology or system. Before purchasing any new technology, look for a statement about HIPAA compliance. Make sure it meets your practice’s needs before investing.
For more information about HIPAA compliance as it relates to telemedicine, read CCHP’s HIPAA and Telehealth Factsheet.
Bottom Line: The Future of Telehealth
If history is any indication, telehealth will look radically different in 2030 than it does today. Each year, CMS approves more services for telemedicine. More communities gain access to reliable broadband each day. New technologies emerge. More and more patients have smartphones and web-enabled devices.
Congress continues to propose—and may enact—laws to promote the use of telemedicine, and states are very active in legislating and regulating it. Vendors of telemedicine technologies are proliferating, and new platforms are born all the time.
Now that you know what to look for, your practice or facility can make good choices in this evolving area. Investing in telehealth can help position your practice for success in 2017 and beyond.