The implementation of telehealth or telemedicine has expanded exponentially since the late 1990s. There’s never been a better time to offer remote care than now, as people want virtual care for its convenience. Plus, for healthcare providers, the widespread adoption of telehealth means it is more profitable than ever.
In the United States, though, healthcare providers who offer remote care must know how telemedicine reimbursement and licensing work.
Many states and medical agencies encourage medical providers to use virtual healthcare, and almost every state Medicaid program has expanded coverage for telehealth services. Meanwhile, private payers have embraced and created new policies for telehealth reimbursement. However, there are still barriers to telemedicine reimbursement.
Moreover, remote care delivery requires healthcare providers to comply with telemedicine licensing requirements to ensure eligibility and compliance.
Although telemedicine has been around for years, there’s still no set standard for telemedicine reimbursement policies, and licensing requirements vary between states.
State policymakers focus on telehealth parity laws to address reimbursement.
State governments and the federal government have made several policy changes to facilitate access to telehealth or telemedicine. One of these policies is enacting parity laws.
Parity laws require health insurers to reimburse for telehealth services the same way they would for in-person services. Passing parity laws demonstrated an expansion in remote care delivery. Most states have parity laws, which is excellent news for those looking to practice telemedicine.
In addition, the Coronavirus Aid, Relief, and Economic Security (CARES) Act includes a payment parity requirement for Medicare, and many private payers followed this example by enacting payment parity for telehealth services. The payment parity requirement may end with the expiration of the public health emergency declaration. However, some states’ Medicare programs could make it permanent.
Currently, 43 states and the District of Columbia (DC) have parity laws that govern private payer telehealth reimbursement:
The states that don’t have telemedicine parity laws include:
- North Carolina
- South Carolina
It is important to note that parity laws come in a variety of forms. Some parity laws apply to provider reimbursements, while others apply to patient copayments, coinsurance, and deductibles; many apply to both. Plus, some payment parity laws require telemedicine reimbursements to be on the same basis as in-person services, while others require reimbursements not less than or more than those for in-person services.
Make sure to always check the state law and telemedicine reimbursement policy where your practice is located and your patient’s health insurance payer.
There are state-specific guidelines for practicing telemedicine across the United States that may affect reimbursement.
Telemedicine providers must comply with clinical guidelines to obtain reimbursement for telemedicine services.
In general, remote care consultations need to follow the same standards of practice as regular in-person visits. However, some states have specific guidelines for practicing telemedicine that could affect reimbursement. You may need to abide by the following:
Pre-Established Provider-Patient Relationship
Before a telemedicine consultation, there should be an initial establishment of a provider-patient relationship. Some states allow the establishment of this relationship via telehealth technology. Always check your state’s specific requirements in advance to guarantee reimbursement for services.
Prescribing medications via telemedicine is under much scrutiny, especially if it involves controlled substances. That is why most states have strict guidelines for ePrescribing. Nearly all states consider it inappropriate when using only an internet or online questionnaire to establish a provider-patient relationship, which is a requirement in online prescribing.
Other states require a physical examination prior to providing an online prescription, while some don’t require an in-person visit but specifically allow the use of telehealth technology to conduct the examination.
Patient Informed Consent
Forty-four states and DC include some sort of consent requirement in their laws, administrative code, or Medicaid policies.
Most states require healthcare providers to obtain patient informed consent before conducting telemedicine consultations. Patients may provide their consent either verbally or in written form. Discussed in the consent is vital information such as the treatment methods and limitations of treatment. The provider includes the consent in the patient’s medical record.
Healthcare professionals must adhere to all applicable statutes and policies governing telehealth informed consent standards.
State and federal governments and insurance payers increasingly recognize the importance of telehealth or telemedicine as they work towards overcoming administrative barriers and making telehealth accessible to all and profitable to healthcare providers.
The current status of state telemedicine laws and reimbursement policies looks good. However, there are still restrictions.
Telemedicine usage continues to surge in the United States as patients and providers look for convenient access and delivery of healthcare. One of the main aspects that contributes to the success of telemedicine is the expansion of state telehealth laws and reimbursement policies.
In October 2021, the Center for Connected Health Policy (CCHP), a national telehealth policy resource center, published a fact sheet on recent updates on telehealth laws and reimbursement policies. CCHP’s summary report includes updates in telehealth policy made between June and September 2021.
The following are CCHP’s vital findings on telehealth policy trends in all 50 states and DC:
- All 50 states and DC have a definition for telehealth, telemedicine, or both
- Every Medicaid program reimburses for live video visits
- 22 states allow audio-only service delivery
- 30 states and DC reimburse home-based telehealth services
- 29 states and DC reimburse school-based telehealth services
Telehealth policy trends vary from state to state, with no two states similar in defining, reimbursing, and regulating telemedicine.
And many telehealth policies continue to have restrictions and limitations, which create a barrier in using telehealth technology to deliver or provide access to care.
Common telehealth restrictions include:
- Qualified patient and provider location
- Eligible healthcare providers
- The type of medical services or current procedural terminology (CPT) codes that are reimbursable
Another limitation when delivering telemedicine services is cross-state licensing.
States are responsible for several aspects of licensing among healthcare professionals. Some states have professional boards that release special licenses or certificates or have exceptions to licensing requirements related to telehealth.
Since the originating site (patient’s location) is where the virtual visit takes place, the laws of the patient’s residing state apply. Therefore, a provider must hold a license active in the patient’s state.
Some states have telehealth-specific licenses that allow an out-of-state provider to render services via telemedicine, as long as they meet certain conditions, such as agreeing not to open a physical office in the state.
Other states have laws not specifically addressing telehealth or telemedicine licensing but allow out-of-state providers to obtain a temporary license to provide telehealth services to patients in the state.
When it comes to cross-state licensing, the situation is as follows:
- 12 states issue special licenses or certificates or have telehealth specific exceptions for out-of-state providers
- Some states enter reciprocity agreements to work together in providing licenses among healthcare providers
- Most states have joined the Interstate Medical Licensure Compact (IMLC) to expedite the process of obtaining a cross-state license
There are currently 29 states and one territory accepting applications for expedited licensure, five states and DC are part of IMLC but have not yet implemented full participation. While five states have had legislation introduced to join the compact.
Standard practices to facilitate telehealth licensing across state lines are adopting reciprocity agreements or interstate compacts that allow eligible healthcare providers to practice medicine and telemedicine in states they are not licensed as long as they hold a valid license and are in good standing in their home state.
For more information, you can check out CCHP’s detailed guide on cross-state licensing.
The IMLC is a well-known interstate compact that allows services to patients in a different state than their provider.
Some states join reciprocity agreements to streamline the licensing process among healthcare providers in member states.
Reciprocity agreements fall into two main areas:
- Special licenses or certificates allow healthcare professionals to provide care without obtaining new and/or additional licenses.
- License reciprocity for out-of-state healthcare providers to practice within their jurisdiction if they meet special license and regulatory requirements.
The Interstate Medical Licensure Compact or IMLC is one of the best solutions to the limitations imposed by cross-state licensing because reimbursement laws heavily depend on the patient and provider’s location.
The IMLC allows healthcare providers to offer telehealth services to individuals situated in another state by obtaining a medical license for said state (a complex process) quickly.
The IMLC is an agreement among participating states to make the licensing process easier for physicians who want to practice telemedicine in multiple states. IMLC also strengthens public protection as the member states share investigative and disciplinary information.
The IMLC became fully operational in 2017. Although it makes telemedicine licensing considerably easier to tackle, it doesn’t guarantee the ability to practice telehealth outside of your state’s borders.
The IMLC allows for an expedited licensure process; physicians still need to apply for a license in individual states.
Each state has a medical board that reviews practitioners’ applications. That means the outcome depends on the board itself. In some states, the provider has to wait two to three weeks for the board to review their application. While in other states, they have to wait a few months.
To become part of the IMLC, healthcare providers must meet several requirements, such as having an unrestricted license in a state that is part of the compact — their State of Principal License (SPL).
To declare a state as your SPL, you have to meet one of the following criteria:
- Your primary residence is in the SPL
- The location of your employer (if any) is in the SPL
- You use the SPL as your state of residence for United States federal income tax purposes
- At least 25% of your medical practice occurs in the SPL
After declaring an SPL, you need to satisfy the following criteria:
- Graduated from an accredited medical school
- Completed an ACGME- or AOA-accredited graduate medical education
- Passed each component of the USMLE, COMLEX-USA, or equivalent in no more than three attempts for each component
- Possess a current specialty certification by an ABMS or AOA-BOS board
- Have no prior disciplinary actions or controlled substance actions against any medical license
- Have no criminal history
- Have no current investigation involving any of the above
Once you meet the above criteria, you fill out an online application. You also need to pay $700 (nonrefundable) and submit fingerprints to your state for a criminal background check.
If the healthcare provider meets all the requirements, their SPL issues a “Letter of Qualification,” allowing the provider to participate in IMLC.
After issuing your license, a state medical board participating in IMLC may ask you for additional information and requirements. As a license holder, it is your responsibility to comply with these requests, and failure to do so may result in action against your license by the issuing state medical board.
Aside from IMLC, there are other active compacts across the country:
- Nurse Licensure Compact
- Physical Therapy Compact
- Psychology Interjurisdictional Compact (PSYPACT)
- EMS Personnel Licensure Interstate Compact
There are other requirements in each state besides licensing to practice telemedicine and obtain reimbursement for your services, like certification.
To be eligible for telemedicine reimbursement, a provider may need certification.
Healthcare providers can deliver telehealth services across state lines, depending on rules set by state and federal policies or as a member of a compact. But for many states, to practice telehealth, healthcare practitioners must get certified first.
Healthcare workers must know how to approach telehealth and use adequate tools, proper communication channels, and correct CPT codes.
To obtain a telehealth certification, healthcare practitioners need to meet specific qualifications proposed by the state of their medical practice. Some of the most common requirements in the majority of states for telehealth certification are:
- Being a United States citizen or having a valid lawful permanent residence or green card to live and work in the country
- At least 21 years of age with good moral character
- Completing the Telemedicine Rules Review Course
- Having a license to practice medicine issued by the state medical authority
- Passing the state’s medical board examination, COMLEX-USA, National Board’s parts 1, 2, and 3, NBOME, FLEX/USMLE steps 1, 2, and 3, or a combination of these tests
Each state has its own rules and regulations on telehealth certification. Healthcare practitioners should check for the complete telehealth certification requirements in the state they practice.
What are the technical requirements for telemedicine?
There are technical requirements for telehealth, which mainly involve integrating technology.
The following are four technical requirements for telehealth that a healthcare provider should implement.
- Reliable Internet Connection
The most vital requirement of telehealth is access to the internet. Without the internet, telehealth is not possible. Physicians (and patients) need a fast and secure internet connection to guarantee that the video and audio quality transmit smoothly for a successful telehealth consultation. Otherwise, a poor internet connection results in low video and audio quality and may even stop working during a consultation.
- Technical Support
Even though telehealth is an innovative solution for healthcare delivery, it is not a technological platform that operates unassisted. Some telehealth systems, such as Curogram, provide round-the-clock tech support with their service. The support team answers questions and concerns regarding software, hardware, and other technical problems. The technical support staff's professional training guarantees they can adequately assist healthcare providers using a telehealth program in their practice. When choosing a telemedicine solution, make sure it includes tech support.
- Reliable Hardware
Choosing hardware for telehealth technical requirements is easy; healthcare providers (and patients) use the technology in their everyday lives, such as smartphones, laptops, or tablets with high-quality cameras and built-in microphones to send and receive clear video and audio.
- Secure Telehealth Platform
Providers need to locate the right telemedicine platform for their needs. Selecting a telehealth platform is crucial. The system must adhere to the Health Insurance Portability and Accountability Act (HIPAA) rules and regulations to prevent violations of the distribution of health data and avoid abuse in healthcare delivery.
Curogram ensures all communication between physicians, patients, and medical staff is secure and HIPAA-compliant. Curogram also has vital features that guarantee successful telemedicine implementation, such as:
- Electronic health record (EHR) integration
- Online appointment booking
- Encryption security
- Reimbursement documentation
Healthcare providers can transfer health information and patient data in multiple ways; it can’t be stressed enough how important it is to have a HIPAA-complaint system like Curogram for telehealth. A properly implemented telemedicine solution provides numerous benefits to both patients and providers.
Why should you use Curogram for telemedicine after gaining a license and understanding reimbursement?
Curogram is a HIPAA-compliant telemedicine platform explicitly made for medical purposes. As a telemedicine solution, its platform comes with countless features, like HIPAA-compliant 2-way texting, to make your work more efficient and effective.
Curogram, unlike other channels, such as Skype, is HIPAA-compliant by default, and offers virtual waiting rooms. Using these features may result in a significant spike in your revenue because, with Curogram, you have an easy interface to work with that enables you to see more patients because of time-saved on routine tasks.