What are the regulations governing Telemedicine

Regulations Governing Telemedicine

Telemedicine requires following the same protocols and standards as defined in HIPAA for any in-person visit. For Telemedicine to be functionally equivalent to in-person medical visits, it may involve transmission of patient data hence requiring all protocols of privacy and security to be rigorously applied. While some of these regulations have been relaxed due to Covid, it would be prudent for providers to choose technologies built for Telemedicine that use advanced levels of security processes including data encryption rather than consumer apps. Given that both provider and patient can be in-home or office settings, adequate diligence should be employed to ensure conversation privacy.

Telemedicine benefits

Telemedicine and Medicare

Since March 2020, CMS has been regularly making changes to its Telehealth Services guidelines expanding the use of Telemedicine to 80 plus services to reduce the need of patients to visit or stay in hospital/clinical premises post procedures to minimize Covid infections. CMS introduced parity for Telehealth services allowing using the same POS code for Telehealth previously used for in-person visits. Virtual check-ins are allowed for new patients. CMS also expanded scope of Telemedicine to include new providers, remote patient monitoring, remote supervision, hospice care and nursing homes.

For more details visit Telehealth guidance section of CMS Covid 19 webpage

Telemedicine and Medicaid

Telemedicine guidelines for Medicaid is dependent on state policy and hence vary from state to state. Some key highlights regarding Medicaid coverage for Telemedicine,

  • 29 states do not specify patient setting, while 12 states recognize home as an originating site while 12 other states recognize schools and schools-based health centers as originating sites
  • 29 states and Washington DC cover Telemedicine through store and forward technology while one-third of the states in US qualify live synchronous Telemedicine applications only for reimbursement
  • 26 states do not specify the type of provider as a reimbursement criteria while the rest allow specific types of providers only
  • 21 states and Washington DC have coverage parity while 28 states also have payment parity policies. Medicaid parity policies have continued to make progress in the last few years

Private Insurance?

Private insurance covers the largest segment (67%) of health insurance coverage out of which 55% is through Employer plans. Employers continue to encourage favorable Telemedicine policies in their plans due to the ease of access and less disruptive nature of Telemedicine for their employees. For private payers, 36 states have coverage parity policies, 16 states have payment parity policies while 12 states have no identified parity policies. The adoption of Telehealth in large employer health plans until 2018 was relatively low (2.4%). However, with the unfortunate constraints of Covid 19, the adoption of Telemedicine has seen a significant uptick.

Vivadox.life has “zero” startup costs for healthcare providers and competitive pricing plans to help them implement a successful Telemedicine program. With continuous progress in both coverage and payment parity made across all payers, Telemedicine is an attractive way for healthcare providers to expand their revenue opportunities.

For more details by state, we recommend State of the States report by American Telemedicine Organization