THIS WEEK IN TELEHEALTH 101…
☎️Telemedicine Back Office Considerations
Telemedicine, also referred to by names such as telehealth, virtual care, and mobile health, is gaining increasing attention in part due to COVID-19. According to the ATA, benefits of telemedicine can include improved access, cost efficiencies, improved quality, and convenience for the consumer in reduced travel times and related stress, among others. Telemedicine encompasses a wide array of services and technologies.
When the topic of telemedicine is mentioned, the initial focus is often on the technology. Another key topic is the back-office activities, which support things like workflow and reimbursement, for example.
Here’s a quick overview of some of the back-office items to consider when designing a telehealth program:
Provider credentialing
Providers (e.g. physicians) must be licensed in the state where they intend to provide telemedicine services.
The provider’s license must be for the state where the patient is located.
Initiating and maintaining an active license is important.
Patient co-pay
A patient may need to make a payment prior to participating in a telemedicine session.
The amount and payment methods vary among telemedicine providers.
Sufficient infrastructure is needed to ensure that payments are received and processed.
Payer billing
The ability for a telemedicine provider to be reimbursed varies by state, payer, and service being provided.
The claim that the provider submits to the payer may need to be processed / coded in a specific manner for reimbursement to be approved.
Accounting
The accounting process in telemedicine includes the components of traditional accounting practices such as accounts receivable, account payable, and reconciling late payments. In addition, the accounting process should be closely managed to ensure accuracy.
Contracting
In certain telemedicine models, such as a hub-spoke telemedicine model between two unaffiliated hospitals, a contract should be used.
The details of the contract will vary based on the service(s) being provided.
Similar to traditional contracting, amendments and/or addendums may be used if contractual changes and/or additional services are offered.
Legal and Compliance Support
Legal input, review, and oversight of the telemedicine program is important for a litany of reasons.
The telemedicine landscape is advancing and changing over time.
Ensuring that representatives from legal and compliance are involved in the telemedicine program is important to support program integrity.
Consent
Depending on the telemedicine model, state where the patient is located, as well as policies and regulations, a patient consent may need to be completed prior to participating in a telemedicine consult.
Verbal and/or written consent may be incorporated into the telemedicine process flow.
If you’re interested in learning more about telemedicine considerations and implementation, we invite you to check out our Telehealth FAQs, search our Resource Center, join us for a virtual Telehealth Town Hall, or sign up for our Innovation Academy: COVID-19 series, beginning Summer 2020.
