Starting a virtual or hybrid practice presents freedom and flexibility that can never be matched by a full-time brick-and-mortar operation. Virtual practices allow practitioners to travel, work from home and treat patients in several states with appropriate licensure. That being said, it’s not as simple as downloading a telehealth program and connecting with a large number of interested patients. To realize the full potential of working virtually, there are a few things that you need to consider beforehand. If you don’t know where to begin to start a telemedicine practice, we can help.
We provide insight on the benefits, hurdles and organizational requirements and help get your practice up and running. We’ll explore some of the best practices and share some helpful tips as well. Remember, this is a general overview of the process, and the information here does not constitute official advice.
In our first post, we will look at 10 things you need to know about starting a telemedicine practice.
Starting a telemedicine practice can feel overwhelming, but Mend is here to help. We help providers start their practice from the ground up every day. Here are a few quick tips to get you on your way.
1. If you don’t have a business already set up, you’ll need to start one.
We recommend contacting a local incorporation attorney, the Small Business Association or your local medical board to get more information on how to get incorporated. They can provide resources on incorporation, bank accounts, business licenses and more.
2. Telemedicine laws vary by state.
You’ll want to familiarize yourself with whether your state has a parity law covering telemedicine. We recommend referencing the American Telemedicine Association’s document on telemedicine coverage to familiarize yourself with what is permitted, i.e., what that law allows explicitly.
3. There are two types of video telemedicine.
Telemedicine laws are generally broken up into two delivery methods: hub-and-spoke and direct-to-consumer.
Direct-to-consumer means that the state or payer allows the patient to be located at home when receiving telemedicine services. The patient doesn’t need a medical staff member present. Patients will self-report vitals (when able), and they may be directed by the practitioner for an in-person follow-up when necessary.
Not all patients qualify for direct-to-consumer telemedicine, and that’s up to the provider to determine a protocol that ensures that only appropriate patients are receiving treatment via telemedicine. Mend can help develop and implement this protocol for providers.
Hub-And-Spoke means that the patient has to be located in an “originating site,” i.e. “spoke,” to speak to a provider who is at the “hub” or another location. The patient cannot be located at home. States and payers that restrict telemedicine to hub-and-spoke have different lists of facilities that qualify as spoke sites. In general, these sites are healthcare facilities, clinics, doctors’ offices, hospitals, etc.
4. Medicare payment for telemedicine isn’t robust… yet.
Medicare does pay for telemedicine visits in very limited instances. Medicare restricts the patient location to specific types of medical facilities, so the patient cannot be located at home. The medical establishment or “spoke” site has to be located in a CMS-designated rural area. You can find out if your clinic or facility qualifies as one by using the locator on the CMS website. There is some movement that indicates telemedicine coverage may change for Medicare patients, but there is no timeline at this present moment.
5. In many states, Medicaid is the best payer for telemedicine.
Many Medicaid plans are very forward thinking about telemedicine because most members have serious problems with access to care. Working with Medicaid can often be your best bet for getting paid for telemedicine services.
6. Some states don’t let you establish care via telemedicine.
Just like insurance coverage, the state policy landscape/laws on whether you can treat a patient for the first time via telemedicine vary considerably. Some states only require face-to-face interaction, and telemedicine is considered face-to-face interaction. However, some states require that you meet the patient in-person, and telemedicine, unfortunately, does not qualify as an in-person visit. Check ATA or your local medical board to know more about your state’s laws before starting your practice.
7. Prescribing varies by location and substance.
State laws vary considerably on who can prescribe medication via telemedicine. Some laws restrict all prescribing, and there are others that allow it for established patients. Some states limit controlled substance prescriptions to specific diagnoses. This is another important thing to follow up with your state medical board about.
8. You can practice across state lines, in some situations.
You most likely need to be licensed in every state where you want to practice. There aren’t many states that allow you to treat patients without some form of license for the area. If you already hold multiple licenses, then, in many cases, you should be able to provide services to patients in all of those states regardless of where you are physically located.
9. If you want to bill insurance, you will need a physical address.
Insurances list doctors by their physical address and zip code. That’s how patients find doctors through the physician locator. If you already have an office where you practice in-person, then use that address for your telemedicine practice.
If you wish to continue with telemedicine practice exclusively, you may want to consider renting a virtual office or executive suite so you can provide a physical address that isn’t your home address.
10. Billing telemedicine is almost as simple as billing in-person visits.
The codes for telemedicine are the same as the codes for in-person visits because the services that you’re providing should be identical.
Bill your office visit code as usual, then add either the GT modifier or the 95 modifier. This varies by payer. You will also change the place of service code from 11 (office) to 02 (telemedicine).
If you still have questions, that’s okay! Once you familiarize yourself with these 10 things, you are on your way to starting your telemedicine business. Mend offers to simplest-to-use telemedicine platform on the market, and we can get you up and running in no time.