Telemedicine North Carolina: All You Need to Know | Blog

North Carolina is yet to embrace all the benefits telemedicine has to offer. The Old North State is a little behind when it comes to parity laws, and the telemedicine champions have been busy with their attempts to convince the authorities that remote care would push the struggling healthcare system in the right direction.

A conservative approach to medicine may prove to be a devastating factor in light of the recent COVID-19 outbreak. The pandemic revealed all the problems of the healthcare system, not only in North Carolina but on the national level as well.

Redesigning the models the States are using to provide for requesting patients is long overdue. Telemedicine is the future of medical practice, especially in those states that suffer from the lack of medical personnel. In the case of North Carolina, the primary issue are the patients in rural regions that do not have adequate access to medical care.

How can telemedicine help?

The North Carolina Medical Board (NCMB) defines telemedicine as the practice of medicine by using electronic communication, or other means of information technology, between a physician in one location, and a patient in another location with or without an intervening healthcare provider.

This implies that an appointment can be a virtual session instead of a traditional in-person meeting. Telemedicine revolutionized healthcare by enabling real-time, live communication between the doctors and those patients that couldn’t receive proper care due to their geographic location. Even though telemedicine is not appropriate for every patient or condition, it still provides an opportunity to democratize many aspects of medical care. Additional benefits of telemedicine are:

1. Reducing the per-capita expenditures that have been going through the roof lately
2. Improving the patient experience by reducing travel time and waiting
3. Speeding up the communication and the exchange of information between the provider and the patient
4. Allowing providers to expand their services
5. Improving the health of the general population

Telemedicine can bridge the gap between the needs and the possibilities in the US healthcare system. The Old North State is not an exception. Residents of the rural areas need better access to medical care, and offering telehealth options can significantly improve the quality and efficiency of service they receive.

Telemedicine and telehealth

Telemedicine and telehealth often overlap. Different states offer different definitions for the two, and officials are yet to reach a consensus on how to use them properly.

Telemedicine usually refers to clinical services, while telehealth refers to non-clinical activities such as health education and disease prevention. NCMB views telemedicine as a broader term that incorporates telehealth although it does not describe the distinction precisely. 

This table sums up the most important concepts in telemedicine.

Telemedicine in North Carolina–Rules and Regulations

The officials may be late with the parity law, but the North Carolina Medical Board did a great job with defining the rules of telemedicine when it comes to the professional aspects of the practice. They offer extensive guidelines that explain all crucial points regarding:

1. Doctor-patient relationship
2. Staff training requirements
3. Evaluation and examination of the patient
4. Prescriptions
5. Keeping medical records
6. Licensure
7. Disclaimers

The Board recognized the opportunities that remote care can offer, as well as the need to define all vital elements of telemedicine. Practitioners should not be left in the dark, and they must be aware of what to do and how to do it to provide responsible and effective services to their patients.

Modern medicine can benefit immensely from advanced technology, according to the Board, and if healthcare providers implement it adequately, it can help with:

• Access to primary and specialist care
• Availability of patient medical records
• Reduction of healthcare costs

Most importantly, NCMB believes that telemedicine practices contribute to overall healthcare outcomes, which is why the Board was a strong supporter of telehealth development.

The most significant concern in any medical practice is the well-being of the patient. The Board focuses on keeping the quality of care on the same level as in the traditional practice. All standards that apply to in-person care and treatments must be met or exceeded in telemedicine as well.

By endorsing the same standards, NCMB clearly states that it will hold accountable and discipline any failures to conform to North Carolina rules of professional medical care, regardless of the model.

Doctor-patient relationship 

The Old North State law does not require the physician and the patient to meet in person to establish the relationship, meaning that the real-time video call is enough. It is important to stress that text messages, emails, audio-only calls, and online questionnaires do not qualify as an appropriate tool of communication in this respect.

Although informed consent is not mandatory for telemedicine in North Carolina, it may be wise to get one. Before the initial telemedicine appointment, all physicians should provide/obtain the following:

• The name, location, and credentials of the healthcare provider
• Verification of patient’s identity and location

In the case of failure to identify the patient, there is a risk of fraudulence and inappropriate disclosure of patient data. Practitioners should also keep precise medical records on all the patients that they see, which must be available to patients and other healthcare providers that are treating them.

Training the Staff

All medical personnel participating in telemedicine must have valid licenses and credentials that should be available upon request. NCMB advises the practitioners to properly train the staff on the technology that is being used for telemedicine.

The ability to understanding the tools and a high level of competence are essential in delivering responsible care to the patients. All employees must be proficient in the technology and aware of its benefits and limitations. It is crucial to choose the right telemedicine platform because it can make or break your practice. We at Curogram offer reliable and user-friendly solutions that can boost your capacities and make many aspects of your service easier.

Examination and evaluation 

Before diagnosing the condition or recommending the treatment, all telemedicine providers must conduct a thorough and appropriate examination and evaluation of the patient. The physician and the patient need not have an in-person meeting during the evaluation, but the Board is clear that the technology must be sufficient to set an accurate diagnosis.

NCMB further advises that the doctor should use all standard medical practices during the evaluation:

• Physical and mental examination
• Patient history
• Necessary diagnostic and lab testing

The doctors must not rely on online questionnaires and medical records updated by patients for proper evaluation. This is a violation of the law and the practitioner may be subject to disciplinary measures of the Board.

Prescribing medication

There is no doubt that online prescriptions have many upsides. That is why both telemedicine and traditional healthcare providers accepted the practice with open arms. NCMB does not oppose to e-prescribing, but it does impose certain limitations on it.

Prescribing controlled substances for pain treatment through telemedicine is unacceptable because it is not consistent with the current standards of care as per the Board. The doctor and the patient must meet in-person for evaluation before such a prescription is issued. 

If the controlled substance is part of the treatment of another condition, the practitioner should comply with all rules and regulations that apply on the state or federal level. The providers must participate in the Controlled Substances Reporting System in both cases.

Medical records

NCMB recognizes the importance of keeping appropriate medical records in telemedicine and recommends adherence to the highest standards that apply to traditional practice. It further advises that if the patient receives both telemedicine and in-person treatment from different physicians, the complete medical record should include all documentation from each provider.

Proper medical records must include recordings or transcriptions of all telemedicine encounters, including emails, video calls, audio calls, and text messages. Additional documents are:

• Instructions provided to the patient by the telemedicine provider 
• Prescriptions
• Test results, scan images, photos, etc.
• All reports from specialists or other consultants
• Notes on allergies and other conditions relevant to the current of future treatments

It is vital to make sure that all means of communication adhere to HIPAA compliance rules and the highest standards of confidentiality, privacy, and patient data protection. The files must be available to patients on request.

With electronic health records (EHRs) becoming a standard in medical practice, the providers can reallocate resources from administration to patient care. The reduction in downtime is possible only if the telemedicine platform the practitioners use integrates with the EHR system. We at Curogram offer a tool that integrates with any EHR, which allows the medical personnel to focus on their primary task–seeing and treating patients.

Licensing

NCMB deems that the telemedicine appointment is “happening” at the location of the patient. This means that the practitioners treating patients who are North Carolina residents should possess a valid medical license to practice in the Old North State. It is not necessary for the telemedicine providers to be residents of the state, or to be located within state borders at the time of the treatment.

All practitioners based in North Carolina who treat residents of other states or countries should check the legislation of the patient’s originating site. Most states require a current license. In some cases, additional permits are necessary, and certain restrictions apply to telemedicine. For further clarification, it would be advisable to check the requirements with the Federation of State Medical Boards.

The licensing procedures may become easier with the Interstate Medical Licensure Compact (IMLC), a program that should help practitioners cut through the red tape. North Carolina is yet to join IMLC.

Disclaimers

The North Carolina Medical Board recommends that any limitations that exist regarding the electronic model used for telemedicine practices should be presented to patients before the treatment. The Board suggests that all advertisements, both online and traditional, must include these disclaimers.

In the case that the telemedicine treatment is not adequate for a particular patient or condition, the practitioner must refer them to the appropriate institution or recommend a different model. Emergency backup plans, applicable in case the patient’s condition deteriorates and they need hospitalization, should also be included in the disclaimers.

Reimbursement

With no private payer parity law in North Carolina to regulate the reimbursement of telemedicine services, most practitioners are still reluctant to establish remote care service or add it to their existing practice.

Private payers

The experience of many other states proves that without the parity law, telemedicine practice cannot develop and become available to a broader public. All the attempts to pass the bill in North Carolina failed, although telemedicine advocates have been doing their best since 2015.

Private payers do not cover for remote care, although some insurance companies may decide to offer this option to the users. The insurers may include certain aspects of telemedicine in their packages, but various limitations might apply in terms of eligible services and geographic locations. 

Medicaid

Medicaid beneficiaries in the Old North State can use some telemedicine services, but many restrictions apply. North Carolina Medicaid defines telemedicine as the use of two-way video and audio communication, happening in real-time, to provide healthcare between places of lesser and greater medical capability when participants who are in different locations are separated by distance.

This definition implies that NC Medicaid reimburses for telemedicine services if:

1. The beneficiary is present at the time of consultations
2. The consulting provider controls the examination
3. The originating site (patient’s location) and the distant site (doctor’s location) are at a sufficient distance, meaning that the patient is unable to reach the provider
4. The communication tool must be an interactive video and audio call

Further requirements state that telemedicine treatment must be medically necessary, appropriate for the diagnosis of the patient and that there isn’t a less costly or traditional option available to the patient in North Carolina.

Telemedicine providers must obtain approval from NC Medicaid for their services and must be enrolled in the Medicaid program. The reimbursement policy does not apply if the patient is in jail or a detention center.

NC Medicaid covers telemedicine and telepsychiatry services provided over live video calls, but not for store-and-forward and remote patient monitoring. Before the appointment, the provider must submit health and other records to prove that the patient and their condition are appropriate for telemedicine services.

Eligible medical providers for NC Medicaid program are:

1. Physicians
2. Nurses
3. Nurse-midwives
4. Physician’s assistants
5. Psychiatrists
6. Licensed psychologists(Ph.D. required) 
7. Licensed clinical social workers

North Carolina telemedicine—What does the future hold?

The old North State failed to pass one of the most progressive telemedicine bills in the country. HB 967 aimed to make clear definitions of telemedicine and telehealth, extend the coverage of services to remote patient monitoring and store-and-forward, and adequately regulate parity law. Telemedicine needs private payers to reach its full potential.

The bill recommended comprehensive performance metrics for telehealth providers that would help determine the quality of remote care services. The law-makers devised a plan that would ensure that all residents get the appropriate online connectivity to be able to use telemedicine.

A great chance was obviously missed in September 2019. The current health crisis came unexpectedly, and while the healthcare system is struggling to stay afloat, the aftermath looks even grimmer. We can only hope that the officials will react swiftly and more responsibly in the near future.

Telemedicine by State

Don’t see your state? We just haven’t written about it yet! Stay tuned on our blog or check out our article on telemedicine reimbursement by state.