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Telehealth for Community Providers

The statutory and regulatory environment is changing rapidly with respect to the use of telehealth during the state of emergency. To support the health and safety of our patients, caregivers and communities, Atlantic Health System is creating a telehealth resource page to provide guidelines to accommodate a more widespread use of services. Updates to information will be provided routinely based on the dynamic nature of the federal and state guidelines at this time.

Please note that these resources were developed by Atlantic Health System for Atlantic Health System use on April 13, 2020. Please use at your discretion. The information provided on this website does not, and is not intended to, constitute legal advice.  All information, content and materials are for general information purposes only and may not constitute the most current information.  


What is telehealth?

Telehealth is the use of information and communications technologies, including telephones, remote patient monitoring devices, or other electronic means, to support clinical health care, provider consultation, patient and professional health-related education, public health, health administration, and other services as described in regulation.

What types of visits do the temporary guidelines support?

Telehealth visits

Use of an interactive audio and video telecommunications system that permits real-time communication between the provider site and the patient located remotely.


Virtual check-ins

Brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image.


eVisits

Non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals.

What is Atlantic Health System doing to support provision of these services?

Atlantic Health System is developing a spectrum of telehealth capabilities that providers will be able to use depending on the acuity and symptom presentation of their patients.

Atlantic Health System is tying video visits into the backend electronic health record (EHR) system, and providing instructions for Atlantic Health System network providers. Atlantic Health System also provides a Virtual Visit app for team members and patients who would like an on demand visit for low acuity conditions.

Other programs are available for remote patient monitoring.

What platforms can be used during the state of emergency?

Atlantic Health System is working to deploy standardized tools to support clinicians, within its network, during this time period.

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency.

For community physicians, during the state of emergency, administrative teleconferencing platforms such as Facetime, Zoom, doxy.me or Skype* may be utilized as long as providers are exercising “good faith” through every day communications. Providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products.

Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.

Facebook Live, Twitch, TikTok, and similar video communication applications that are public facing must not be used in the provision of telehealth by covered health care providers.

*this list does not constitute an endorsement, certification, or recommendation of specific technology, software, applications, or products.

What types of things should you think about before providing services?

Before using telehealth to treat your patients, providers should address the following items:

  • Documentation – Practices should ensure that the following items are documented: provider location at the time of the encounter, patient location at the time of the encounter, patient consent and appointment duration. Also document the type of platform utilized. Additionally, claims should include the appropriate telehealth place of service codes and modifiers applied.

  • Workflow – Practices should consider identifying who will perform which tasks before, during and after the consultation. It is important that workflows designate who is responsible for scheduling and patient outreach. 

    Below are a few workflow best practices
    • If available, dual monitors allow video on one screen and documentation on the other.
    • If you are balancing in person and telehealth visits, consider blocking time for telehealth visits.
    • Set up dedicated space to do virtual visits and ensure the equipment is functioning properly. Make sure you have a clean background and make reasonable accommodation for privacy (e.g. closed door, no one walking in or out of space, etc.).
    • Have a contingency plan if the technology fails or if the patient does not have a supported mobile device, tablet or computer.
    • Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications.
       
  • Technology
    • Hardware - Video consultations require camera access at both the provider and patient end, so be sure that cameras/headsets are installed on your mobile devices or workstations. Also, depending on the platform there may be restrictions on the type of browser that can be used (Chrome, Firefox, Internet Explorer, etc.), the type of device that can be used (Smart Phones, Tablets, or Desktops), and the manufacturer (Apple devices vs. Android).
    • Software/Platform - See section on "What platforms can be used during the state of emergency?"
       
  • Billing - Waivers currently apply for professional billing only. Be sure to consult payer specific policies. While there have been changes in Medicare specific guidelines, it is up to commercial carriers’ discretion to align with Medicare policies with the exception of Medicare Advantage plans. There is more information on billing below.

What about HIPAA?

The Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced that it will exercise its enforcement discretion and will waive potential penalties for HIPAA violations against health care providers that serve patients through everyday communications technologies during the COVID-19 nationwide public health emergency.

How do you establish provider patient relationship via telehealth?

Provider patient relationships are established by verifying patient identity, providing physician identify, reviewing medical history and verifying standard of care is met.

Does it matter where the provider/patient is located?

For Medicare, patients will have the ability to receive telehealth services regardless of their physical location. Under normal circumstances, Medicare requires that the patient must be in a rural designated area or in an approved site (like a hospital or physician’s office). This restriction has been lifted and the patient may receive these services in their home, which removes the patients need to travel to a medical facility and in return will lower the risk of spreading the virus to others.

NJ Medicaid has also issued guidance waiving site of service requirements for telehealth, allowing NJ licensed clinicians (such as physicians, nurse practitioners, clinical psychologists, and licensed clinical social workers) to provide telehealth from any location and allowing individuals to receive services via telehealth from any location. They will permit use of alternative technologies for telehealth such as telephonic and video technology commonly available on smart phones and other devices and will permit reimbursement to providers for telehealth, including tele-mental health services, in the same manner as for face-to-face services as long as the services are performed to the same standard of care as if the services were rendered in-person.

If you have patients located in other states, what about licensure?

While Medicare has temporarily waived requirements that out-of-state providers be licensed in the state where they are providing services when they are licensed in another state, individual states have specific guidelines for licensure that may limit or prohibit providing care to patients in other states. NJ, PA and NY have issued guidance. Providers should check other state’s laws before providing services.


The state of New York

New York

In New York a COVID executive order was issued was passed so that to the extent necessary they will allow physicians licensed and in current good standing in any state in the United States to practice medicine in New York State without civil or criminal penalty related to lack of licensure.


Pennsylvania

For Pennsylvania, out-of-state practitioners must:

  1. be licensed and in good standing in their home state, territory or country.
  2. provide the Pennsylvania board from which they would normally seek licensure with the following information prior to practicing telemedicine with Pennsylvanians:
    1. their full name, home or work mailing address, telephone number and email address; and
    2. their license type, license number or other identifying information that is unique to that practitioner's license, and the state or other governmental body that issued the license.

The state of NJ

New Jersey

A practitioner who is not licensed or certified to practice in New Jersey may provide health care services under the bill using telemedicine and telehealth, provided that:

  • Practitioner is licensed or certified to practice in another state
  • The services provided by that practitioner are consistent with the practitioner’s authorized scope of practice in the jurisdiction that issued the practitioner’s license or certification
  • Unless the practitioner has a preexisting provider-patient relationship with the patient that is unrelated to COVID-19, the services provided are limited to services related to screening for, diagnosing, or treating COVID-19; and
  • In the event that the practitioner determines that a telemedicine/telehealth encounter with a patient located in New Jersey will not involve screening for, diagnosing, or treating COVID-19, and the practitioner does not have a preexisting provider-patient relationship with the patient that is unrelated to COVID-19, the practitioner advises the patient that the practitioner is not authorized to provide services to the patient, recommends that the patient initiate a new telemedicine or telehealth encounter with a health care practitioner licensed in NJ, and terminates the telemedicine or telehealth encounter.

What about prescribing?

While the DEA is adjusting federal regulations for prescribing of schedule II substances NJ law is still in effect.

In New Jersey, a provider may prescribe Schedule II controlled substances via telemedicine only after conducting an initial in-person examination of the patient. Subsequent in-person exams are required every three months for the duration of time that the patient is being prescribed the Schedule II.

What is “Webside” Manner? Are there examples of how to do a video visit?

The same standard of care must apply for virtual visits and in-person visits. However, there are best practices for telehealth etiquette >>  
(Source: South Central Telehealth Resource Center; California Telehealth Resource Center Telehealth Program Developer Kit).

Best practices for telehealth visits.

What should I know about camera angles?

Lighting and angles are important factors in the quality of a virtual encounter. The table below shows some of the do’s and don’ts of camera angles and lighting. (source: California Telehealth Resource Center Telehealth Program Developer Kit)

Do's and Don'ts of camera angles.