Healthcare delivery disruptions by the COVID-19 pandemic, relaxation of telehealth regulations, and increased reimbursement rates have dramatically increased the use of telehealth modalities, particularly video conferencing with patients as an office visit alternative. It is important to remain mindful of the standard of care, which generally remains constant even within this alternative healthcare delivery environment. In fact, all of the risk mitigation and patient safety tools normally used in the delivery of patient care (e.g., thorough communication, care coordination, and documentation) should continue before, during and after a telehealth encounter. Consider the following recommendations:
- If you are treating patients across state lines under a COVID-19 temporary state or federal licensure waiver or modification, follow licensure updates in those states to ensure you do not inadvertently violate licensure laws as a result of the expiration of an emergency waiver. The Federation of State Medical Boards website has a COVID-19 webpage that includes links to current state licensing requirements, including States Waiving Telehealth Licensure Requirements, the Center for Connected Health Policy (CCHP) maintains a COVID-19 cross-state licensing page, and the Alliance for Connected Care maintains a Telehealth and Licensure Flexibilities During COVID-19 and Current State of Emergency Waivers page. These resources appear to be regularly updated to reflect changes in state licensing laws.
- Use a secure system and otherwise comply with HIPAA, even when using video telephony technologies that historically have not been considered compliant with HIPAA (e.g., FaceTime).
- Stay apprised of the status of the Office for Civil Rights Enforcement Discretion for Telehealth Remote Communications During the Pandemic, and be prepared to transition to HIPAA-compliant video conferencing platform when required.
- Ensure internet speed and bandwidth are adequate for video conferencing and other means of telehealthcare delivery. (More information is on the HealthIT.gov website at What is the recommended bandwidth for different types of health care providers.) Test your video conferencing capabilities with a trusted colleague to gauge patient experience and remedy problems.
- Use hardware that provides patients with a technologically appropriate healthcare experience (e.g., ensure picture clarity is appropriate to accomplish an examination).
- Communicate the availability of telehealth at your practice, the method for scheduling a visit, and a description of what a telehealth visit will entail.
- Determine whether telehealth is appropriate for the particular patient.
- Ensure the patient has the technology and connectivity necessary to be adequately examined, the capability to utilize the technology needed, and a condition that does not require an in-person visit. Have a back-up plan, such as switching to a telephone conference or rescheduling an in-person examination.
- Ensure the patient is appropriately identified before delivering care or prescribing medication. Some ways to authenticate the patient include:
- Asking the patient to hold up a driver’s license to the camera and comparing the information on the identification card to the information provided by the patient
- Running an insurance eligibility check, then confirming the patient’s name, address, date of birth and Social Security number
- If the patient has been seen before, asking a series of questions about prior medical history to determine if the patient responses match what is in the medical records
- At the start of the telehealth visit, set expectations for the patient. For example, acknowledge that a telehealth visit may not feel as personal as an in-person visit, but emphasize that the patient is still receiving quality healthcare.
- Bring structure to the telehealth visit by setting an agenda; asking for and identifying the patient’s primary concerns and priorities for the visit; and at the end of the visit, summarizing the plan of care, and emphasizing any follow-up concerns.
- Document the telehealth encounter as you would any patient encounter, including all communications with or about the patient; tests and results; follow-up recommendations; and coordination of care, etc.
- The NORCAL Group COVID-19 Telehealth Consent Form can be used to facilitate the informed consent process.
- Document the informed consent process, including that the patient agrees to and understands the limits of confidentiality when communicating via an electronic medium and that it may be determined that telehealth is not appropriate for the diagnosis and treatment of his or her condition.
- Document any technical issues that interfered with, delayed, or complicated the telehealth encounter. For example, poor internet connectivity or signal quality, camera or device malfunction, patient inability to manage technical aspects of the exam, or peripheral device unavailability.
COVID-19 Telemedicine Resources
- American Medical Association: AMA Quick Guide to Telemedicine in Practice
Guidance to support physicians and practices in the implementation of telemedicine during the pandemic, including links to the AMA’s various telemedicine resources, including their Digital Health Implementation Playbook series - The Center for Connected Health Policy: COVID-19 Related State Actions
Detailed descriptions of state COVID-19 telehealth-related laws, regulations, and policy, including reimbursement regulations - HHS: Telehealth: Delivering Care Safely During COVID-19
Discussions of HIPAA flexibility, waivers from CMS, cost-sharing for patients in federal health care programs, billing, and reimbursement - The National Consortium of Telehealth Resource Centers: COVID-19 Telehealth Resources
General COVID-19 telemedicine resources and links to specific state and regional telehealth resource centers - Health Resources & Service Administration (HRSA): Billing for telehealth during COVID-19
Descriptions of how telehealth claims are reimbursed by federal government, state Medicaid programs, and private insurers during the pandemic - The Center for Medicare and Medicaid Services: Covered Telehealth Services for PHE for the COVID-19 Pandemic
Covered Medicare telehealth services for the COVID-19 pandemic. List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth. - NORCAL Group: Virtual Consultations: Risk Management and Patient Safety During the Pandemic and Beyond
Patient safety and risk management recommendations specific to delivering care over an electronic medium - NORCAL Group: Telemedicine & Communications: COVID-19 Resource Bundle
Telehealth consent strategies; downloadable COVID-19 Telehealth Consent Forms; Resource Documents addressing telephone liability, texting, email, and patient portals; and Claims Rx articles on telemedicine risk management, and HIPAA data breach prevention
