Blog January 8, 2023
Telehealth Billing and Regulatory Compliance

In the United States, the types of medical services that can be billed as telehealth vary depending on the payer (e.g., private insurance, Medicare, Medicaid) and the state in which the telehealth service is provided.  In general, telehealth services are defined as healthcare services that are provided using electronic communication technologies, such as videoconferencing, telephone, or email, instead of in-person. Telehealth services can include a wide range of medical, diagnostic, and treatment services, such as consultations, evaluations, diagnoses, and follow-up care.

 

Medicare, the federal insurance program for seniors and certain disabled individuals, covers a wide range of telehealth services, including office visits, mental health counseling, and preventive health screenings. Medicaid, the federal-state insurance program for low-income individuals and families, also covers a range of telehealth services, but the specific services covered can vary by state. Private payers may also cover telehealth services, although the specific covered services can vary by plan.

 

Telehealth and telemedicine services are subject to a variety of regulatory requirements at the federal and state levels. These requirements are designed to ensure the safety, quality, and effectiveness of these services, as well as to protect patient privacy and security.  At the federal level, telehealth and telemedicine services are subject to the same regulatory requirements as in-person healthcare services. This means that providers must meet all applicable licensing and credentialing requirements and follow all relevant laws and regulations related to patient care, including HIPAA (the Health Insurance Portability and Accountability Act) and the HITECH Act (the Health Information Technology for Economic and Clinical Health Act).

 

In addition, there are several federal programs and initiatives that provide funding and support for telehealth and telemedicine services, including the Federal Communications Commission’s Rural Health Care Program, which helps to provide broadband connectivity to rural healthcare providers, and the Centers for Medicare and Medicaid Services’ telemedicine program, which reimburses eligible healthcare providers for telehealth services provided to Medicare beneficiaries.

 

At the state level, telehealth and telemedicine services are subject to a variety of regulatory requirements, which can vary significantly from state to state. For example, some states have laws that require providers to meet specific standards for the use of telehealth and telemedicine technologies, while others have laws that define the types of services that can be provided via telehealth. In addition, some states have laws that allow providers to practice across state lines via telehealth, while others do not.

 

In Florida and Missouri, telehealth visits are subject to the same regulatory requirements as in-person healthcare visits. This means that providers must meet all applicable licensing and credentialing requirements and must follow all relevant laws and regulations related to patient care, including HIPAA (the Health Insurance Portability and Accountability Act) and the HITECH Act (the Health Information Technology for Economic and Clinical Health Act).

 

In addition, Florida and Missouri have several specific laws and regulations related to telehealth. For example, Florida and Missouri law requires that a licensed healthcare provider conduct telehealth visits and that the provider be authorized to practice in the state. Florida law also requires that telehealth visits be conducted using secure, HIPAA-compliant technology and that providers maintain appropriate documentation of telehealth visits.  In Florida, telehealth visits are generally covered by private insurance and Medicaid, subject to the terms and conditions of the relevant plan.

 

However, there are some types of medical services that may not be suitable for delivery via telehealth due to the need for in-person evaluation or treatment.  For example, some medical procedures and treatments, such as surgery or certain types of specialized care, may not be suitable for delivery via telehealth due to the need for hands-on examination or treatment. In addition, certain types of medical equipment and diagnostic tests may not be compatible with telehealth delivery due to the need for in-person monitoring or interpretation.

 

Overall, it is important for providers in Florida, Missouri, and other states to be aware of and comply with all applicable regulatory requirements when offering telehealth visits in order to ensure the safety and quality of care for patients and to protect providers from legal liability.