Decide what type of telehealth services you want to provide. This can range from email communication all the way to video conferencing augmented with digital examination equipment including stethoscopes and high-resolution cameras. The former generally is not a billable service, though telephone follow-up appointments can be billed under some circumstances. The latter can be billed if your state has a coverage parity law permitting telemedicine to be covered.- Consider video chatting without an exam. Video conferencing at home without an exam is usually not a billable service. There are concierge services that charge patients a flat fee for access to a provider. By not going through health plans, billing and coding is not a problem. You might consider offering this type of service.
- Or, stick with billable services. Patients will need to go somewhere they can be examined remotely. Ideally a telefacilitator will run the equipment. This can be a nurse or respiratory therapist, though technically anyone can do it. You could talk with hospitals or clinics that have telehealth facilities to discuss whether you could provide services using their equipment. That is the easiest way to get set up.
- Have all your moving parts in place. To see patients, you will need a way to send prescriptions electronically and, if your patient is at a remote location, print educational materials they can take home. There also should be someone at the distant location who can perform spirometry and other procedures needed. Allergy skin tests are problematic because the provider really should be on-site for safety purposes. The same goes for allergy shots. You might need to use a blood test for allergy testing. Other procedures will require the patient to travel to your location.
- Choose your schedule. You will want to decide whether to offer a full day of telemedicine services or whether to intersperse patients seen in person with telehealth patients. An advantage of the latter is that your volume of telehealth patients is driven by demand.
- Look into credentials. If you provide telehealth services from a hospital facility, you will need to obtain separate telemedicine privileges. Most hospitals that have telehealth facilities will have this process defined.
Decide what type of telehealth services you want to provide. This can range from email communication all the way to video conferencing augmented with digital examination equipment including stethoscopes and high-resolution cameras. The former generally is not a billable service, though telephone follow-up appointments can be billed under some circumstances. The latter can be billed if your state has a coverage parity law permitting telemedicine to be covered.Jay Portnoy, MD, FACAAI
