Telemedicine in Tennessee: Rules and Regulations | Blog

Most of the limitations regarding telemedicine practice in Tennessee were removed with the update of the parity law in 2016. The practitioners from the Volunteer State got the chance to expand their scope of work in terms of geographic locations and the types of services they provide.

Private payers, health plan users, and Medicaid cover for telemedicine services in the same way they do for traditional practice in Tennessee as of 2016. Reimbursement is one of the crucial elements for the development of remote care, and the officials realized that on time.

With the COVID-19 pandemic, the benefits of telehealth are becoming evident. The U.S. healthcare system is proving to be inefficient, even though enormous funds are pouring into it every year. The need for remodeling is long overdue. Some states were conservative in their approach to telemedicine, and they are now struggling to provide for all the patients during the national health crisis.

What Is Telemedicine and Why Is It Helpful?

According to the Tennessee medical practice regulations, telemedicine is the application of secure video conferencing or store-and-forward methods to provide or support healthcare delivery. It replicates the interaction of a traditional encounter between the practitioner and the patient, although the involved parties are at remote locations. Email, text message, and audio-only communication do not qualify as telemedicine practice in the State of Tennessee.

Using advanced technology in healthcare is hardly a new idea. The use of digital communication as a substitute for the usual in-person contact between the doctor and the patient is. Many medical professionals and politicians shied away from this model, concerned whether it is capable of maintaining the quality of service in the medical practice. Despite these reservations, telemedicine turned out to be helpful in many aspects of healthcare. Some of the direct benefits are:

1. Enabling easier access to treatment to people who live in distant locations or rural regions
2. Releasing the pressure off hospitals and allowing them to focus on patients with acute and emergency conditions
3. Reducing the cost of care for both providers and recipients of healthcare
4. Making remote monitoring more available and effective

Tennessee authorities recognized the upsides of telemedicine and adjusted the legislation to help practitioners incorporate these services into their practice. Many Tennesseeans live in rural areas with poor access to even primary medical care, let alone specialists. The fact that around 63% of the Volunteer State residents suffer from at least one chronic medical condition is enough to realize the importance of swift and timely reactions and constant monitoring.

Introducing remote care as a possibility democratized the medical practice by improving its availability. Patients with chronic illnesses can communicate with their doctors in real-time, which can be life-saving in case they suffer from cardiovascular problems or diabetes.

Telemedicine cannot replace traditional practice entirely, but it can serve as a triage. Assessing the condition of the patient via telehealth saves time and money. The doctors can decide who needs additional treatment and when, and then advise on further action, while the hospitals can admit only those patients that need to be there.

Telemedicine and COVID-19

Tennessee and other states that have proper telemedicine regulations seem to have a better response to the current pandemic than those who have been reluctant to embrace remote care. The U.S. healthcare system is not up to the demanding task of providing for all the patients during the global health crisis. Telemedicine proved to be helpful in:

1. Allowing the patients with issues not related to COVID-19 to seek treatment without the risk of being exposed to the virus
2. Enabling the patients with chronic conditions to continue their treatment uninterrupted by the current pandemic
3. Allowing the hospital personnel to focus on difficult cases and reduce the possibility of contamination in medical facilities

The outbreak proved that the majority of medical visits could be conducted online. Telemedicine practitioners in the Volunteer State experienced a significant increase in the demand for virtual appointments, even from patients that were unwilling to use such services before.

Telemedicine seems to be the future of medical practice. Tennessee is an excellent example of a forward-thinking approach that is essential in times of emergency.

Telemedicine and Telehealth in Tennessee

The State of Tennessee law does not differentiate between telemedicine and telehealth. With the lack of clear distinction on the federal level, all states define the terms in their way. Telehealth is considered to be a broader term in some jurisdictions, and it incorporates health education and disease prevention.

Although the meaning of both words is the same in Tennessee, the providers should be aware that they must use them according to the definition valid in the patient's state of residence. 

Tennessee Telehealth Rules of Practice

The Tennessee Board of Medical Examiners (TBME) provides extensive guidelines on the proper way to practice telehealth. Some of the previous limitations were lifted with the update of the law in 2015. Many providers established telemedicine or incorporated the services into their existing practice. The main reasons are advanced reimbursement regulation, high demand, and comprehensive legislation.

The TBME's guidelines provide answers to all frequently asked questions when it comes to telehealth:

• Who can practice telemedicine in Tennessee?
• How to establish a doctor-patient relationship?
• Is it possible to prescribe medication via telehealth?
• How to keep proper medical records?
• What are the proper communication channels?

Even though the Board showed some reservations towards telehealth in the beginning, the new law proved that they realized and accepted the practice entirely. Its primary concern was ensuring the well-being of the patient and keeping the quality of service on the highest level. All the rules require telehealth practitioners to amount to the same standards that apply to traditional medical care.

Who Can Practice Telemedicine in Tennessee?

According to the TBME, the location of the patient, aka the originating site, is where the virtual visit is happening. This means that the providers offering telemedicine services to Tennesseeans must have a valid medical license for the Volunteer State.

If a practitioner is based in Tennessee, and they treat patients from other states, they must have a medical permit valid in the patient's location. There are several exceptions to this rule:

• A physician licensed in a different state may consult with a licensed Tennessee healthcare provider on specific clinical or scientific matters
• Unlicensed practitioners may participate in the treatment by advising the licensed provider without compensation
• Physicians may offer their expertise regarding rare or orphan diseases to research hospitals with compensation

The cross-state licensing became easier when Tennessee joined the Interstate Medical Licensure Compact (IMLC). This program allows for the faster procedure in obtaining the required permits for telemedicine. IMLC is vital for increasing accessibility to specialist care and for broadening the telehealth network nationwide.

How to Establish a Doctor-Patient Relationship?

It is not mandatory to have an in-person encounter for establishing a valid doctor-patient relationship in the State of Tennessee. The definition states that interactive video conference, or at least store-and-forward technology, must be used during the visit. In the case of store-and-forward, all the relevant medical information must be forwarded to the practitioner.

TBME will consider the relationship appropriate if the following happens upon the first encounter:

• The patient discloses all the relevant medical information via real-time video call or at least store-and-forward technology
• The practitioner verifies the identity and the location of the patient
• The physician provides their name, credentials, and current practice location
• The patient provides informed consent, permitting the treatment in full knowledge of the capabilities and the limitations

The practitioner is responsible for informing the patient about the details of the technology being used for telehealth. This includes data security and privacy protection. They should also provide information about emergency backup plans, in case telemedicine services do not suffice in providing the appropriate standard of care.

Telehealth providers may request assistance from other medical professionals regarding the treatment, but they should do so only with the permission of the patient. If the medical data or telemedicine tools are not enough for proper diagnosis or treatment of the patient, the doctor should advise on a more appropriate course of action.

Is It Possible to Prescribe Medication via Telehealth?

The Tennessee Board allows the practitioners to prescribe medication online without the in-person contact. It advises that integrating with e-Prescription System is an excellent way to ensure the patient's safety and avoid errors.

Since telehealth providers must adhere to the same standards of traditional practice, every practitioner should do the following before prescribing medication:

1. Perform an adequate physical examination
2. Go through the patient medical history
3. Make a diagnosis based on the examination and necessary diagnostic and laboratory tests
4. Come up with a treatment plan and explain it to the patient, disclosing all risks and benefits to the patient
5. Ensure the availability of the appropriate follow-up care

If during the evaluation, the physician determines that the patient should receive medication, they are allowed to prescribe them via telehealth. The restrictions apply to prescription of controlled substances for chronic pain treatment because telemedicine is not an appropriate service for this condition. 

The federal law prohibits prescribing certain substances through telehealth and requires an in-person visit. Providers should inform themselves about and act in accordance with federal legislation.

How to Keep Proper Medical Records?

Keeping proper medical records is mandatory in both telemedicine and traditional practice as per the TBME. The same standards apply to both models, and failing to comply with the rules is subject to disciplinary measures.

Adequate medical records should consist of:

• Recordings or transcripts of all communication between the provider and the recipient
• Test results, scans, and other relevant information regarding the treatment
• Prescriptions
• Instructions from the provider or other consulting professionals who participated in the treatment
• Patient's medical history prior to the treatment if it is available

Medical records are private documents, and they should be disclosed only in accordance with state and federal laws. They should be available to the patient on request.

What Are the Proper Communication Channels?

All communication between the provider and the recipient during the telemedicine treatment must be conducted through secure channels that respect the patient's privacy and data protection. The Board recognizes only video calls and store-and-forward technology as adequate for telehealth, and the practitioners should only use the tools that comply with HIPAA standards.

The practitioners may use additional means of communication during the treatment, such as emails, chat, text messages, and audio calls. They are subject to the same rules, so the entire telehealth platform should have encryption and password protection to prevent any third-party breaches. Failing to meet these standards is punishable by state and federal laws.

Curogram offers various interactive channels that can fit different aspects of your practice. Both internal and external communication is quick and HIPAA compliant. To check out some of Curogram’s exceptional features, register for a free demo! 

Reimbursement for Telemedicine in Tennessee

The HB 699 bill approved in 2015 changed the way the providers practiced telemedicine in Tennessee. Besides regulating all the professional aspects of telehealth, it mandated the coverage for the remote care to private payers, employee health plans, and Medicaid.

Before this bill, all insurers could deny coverage for telehealth. The practice was reserved for rural areas or emergency cases without access to appropriate care. It was not enough for telemedicine to develop and reach its full potential.

With HB 699, the situation changed for the better. Tennessee has one of the most progressive remote care policies in the country.

Private Payers

The parity law mandates private payers to reimburse for telemedicine in the same way they do for traditional practice. Live video conference and store-and-forward classify as appropriate means of transmitting medical data.

The insurer must not deny coverage for the service solely because it is available via telehealth. They can do so if they deem that the treatment is not adequate or safe for the patient.

Insurance entities must reimburse telemedicine services regardless of the geographic location of the patient. The patient's home qualifies as an eligible site for virtual visits. The same fees must apply to telemedicine and in-person services.

Medicaid

TN Medicaid defines telehealth as real-time, interactive video and audio communication or store-and-forward technology between the provider, who is at a qualified site, other than the site of the recipient. The recipient should also be at an eligible site staffed with healthcare professionals.

Appropriate sites for the patient are:

1. Practitioner's office
2. Hospital
3. Rural health clinic
4. Federally Qualified Health Center (FQHC)
5. School clinic
6. Any location deemed acceptable by the insurer

Since TennCare, Medicaid's Tennessee agency offers its services through Managed Care Organizations (MCOs), the interpretation of the rules may vary depending on the MCO. This means that the patient's home may qualify as an eligible site by some organizations, but that is not a general rule.

The same goes for store-and-forward. Although Tennessee parity law acknowledges this technology as telehealth, some MCOs will only cover live telemedicine. TennCare organizations are only obliged to reimburse for crisis-related services.

Choosing the Right Telemedicine Platform in Tennessee

With strict regulations in place, it is crucial to choose the right telehealth platform in the State of Tennessee. Technology is a vital aspect of the practice, and it can make or break the business. The key requirements are a user-friendly interface, advanced and secure communication tools, integration abilities, and technical support.

One of the most significant benefits of telemedicine is reducing administrative work. It allows for a better allocation of resources. This means that medical personnel can focus on patients instead of documents and files. A functioning platform is essential in enabling this. Only with reliable technology, telemedicine practice can provide secure and responsible services to the patients.

The Curogram platform offers comprehensive solutions for telemedicine that include:

• Two-way texting feature that allows sending appointment reminders, rescheduling, and secure and quick exchange of information
• The interface that mimics the workflow environments, such as virtual waiting rooms
• Advanced and secure internal communication tool for the employees
• Integration with over 700 EHRs (electronic health records) which prevents manual or double entries

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.