Telemedicine, the practice of having patient care conducted at remote sites through electronic technology, is projected to grow at a rate of more than 50 percent annually for the next several years.

Promoted heavily through the Patient Protection and Affordable Care Act, it’s been the subject of many state legislative initiatives in the last several years.

It might be the best method of delivering quality health care in remote and rural locations. However, it also is an area with which the law has not kept pace with technology.

Accordingly, there are a few legal traps for the unwary as we expand patient access, improve efficiencies and deliver specialty care to underserved populations.

First, the rules for telemedicine delivery vary greatly by state, with some offering service via teaching hospitals and others integrating it through Medicaid.

In addition, there is a lack of national standardization for the delivery model.

Such lack of uniformity presents potential legal and practical issues for care providers who want to use telemedicine as part of their practice.

While the precise nature of telemedicine programs can vary considerably, the most common challenges are the following.

Licensure

As a general rule, providers must be licensed or have legal permission to practice both at his or her physical location as well as where the patient is located. If either point is in a state in which the provider lacks licensure, the physician must resolve it before proceeding.

Credentialing

Similar to licensure, if the patient to be seen or the service to be delivered is in a setting that requires credentialing, the physician should make certain that all requisite credentials are obtained.

Insurance

While an outright exclusion for telemedicine in an insurance policy is unlikely, practitioners should advise their professional liability carrier of proposed telemedicine services and obtain coverage confirmation. This is because the statement made to the carrier about the nature of the practice and places of practice will be different, even if the physician does not leave the home office.

Billing and coding

Reimbursement under telemedicine varies significantly by state, as do the types of third-party payors that will pay for the services. In addition, requirements for billable encounters vary by program.

Finally, since reimbursement amounts might vary when the encounter is divided between physician and facility services, encounters need to be coded properly to avoid later refund obligations.

Medical records and privacy

Creation and maintenance of medical records for patients at the remote site is the provider’s legal responsibility. Prudence dictates that one also ensure that appropriate agreements such as business associate agreements are in place for third parties that might transmit such data.

Delineation of services

A written delineation of the responsibilities of the parties at both ends of the transaction is prudent, though this will vary significantly based upon the nature of the transaction.

Coordination with other supporting professionals

Providers also should inform their key support professions that they are performing telemedicine because of potential tax, expense, remote site regulatory and compliance implications.

Review telemedicine services

As technology improves, the scope of telemedicine services should grow exponentially. Ultimately, we might see a standardized system. In the interim, it pays for the practitioner to conduct a review of any telemedicine service by contemplating the challenges before beginning a program to resolve potential problems.