Regulations and Reimbursement
Liability Insurance
Liability is frequently a concern of providers making themselves available for consultation over telemedicine; however, this concern is often overstated. Most medical malpractice insurance companies do require that providers disclose whether or not they are providing consultations over telemedicine, but often this disclosure does not result in an increased policy premium.
A comprehensive or “umbrella” medical liability policy may cover providers for when they practice telemedicine. In fact, compared with telephone consultations, the use of telemedicine technologies may reduce exposure to malpractice lawsuits, because the consultant may be able to obtain a more comprehensive evaluation of the patient.36 This is particularly true for practitioners providing consultations to remote patients in emergency situations, in which telephone consultations are common and a thorough evaluation cannot be conducted.A standard recommendation for those practicing telemedicine is to contact the insurance provider to disclose that consultations are being provided over telemedicine and allow the insurance provider determine whether additional coverage is needed.37 A primary concern would be if consultations are provided across state lines, where liability legislation, such as malpractice insurance caps, may vary.37 If a medical provider is not insured by a personal or group policy, there are several insurance companies that provide telemedicine specific malpractice coverage for those not otherwise covered by a more comprehensive policy.
Credentialing and Privileging
In 2010, the Centers for Medicare and Medicaid Services (CMS) enacted legislation defining rules regarding credentialing and privileging for physicians and practitioners providing telemedicine services. These new rules streamline the process that hospitals partnering to deliver telemedicine services use to credential and grant privileges to telemedicine physicians.
A hospital that provides telemedicine services to its patients via an agreement with another hospital is now allowed to rely on information furnished by the hospital where the consultant is located (often the larger medical center). This new ruling reduces the burden and duplicative nature of the traditional credentialing and privileging process for hospitals that are engaged in telemedicine agreements, while still assuring accountability to the process.Reimbursement
Practitioners are able to bill Medicare for telemedicine reimbursement (HR 5661 and HR 6331) for specified Current Procedural Terminology (CPT) codes38,39; however, some restrictions apply, including that the patient receiving the telemedicine consultation must be located outside of a metropolitan area. Similarly, for Medicaid, services rendered via telemedicine can be billable and reimbursed at similar rates as in-person medical services, provided the state has passed legislation expanding their Medicaid services to include telemedicine. Currently, more than half of the states have expanded Medicaid to cover telemedicine services, but there are often varying stipulations.40,41 Reimbursement from private insurance companies vary but most often are similar to Medicare and local state Medicaid guidelines.42,43
More on the topic Regulations and Reimbursement:
- I PRACTICE MANAGEMENT ^20 ^110 ^140
- I ETHICAL ISSUES ^10 ^96 ^179 ^352
- I RISK MANAGEMENT ^177 ^197
- Status of a Deputy: The Free Mandate, Its Limitation and Protection
- COMPLEMENTARY AND ALTERNATIVE MEDICINE ^225 ^588 ^647
- Assisted Conception and Multiple Pregnancy
- Approaches to Institutional Analysis