Getting Started with Telehealth

Note: This content is informational only and not intended to endorse any specific products or services.

Telehealth Essentials: Insurance, Cybersecurity, and Compliance

• Insurance Considerations for Telehealth Services
  • Professional Liability Coverage: Verify that your professional liability insurance includes telehealth services. For example, Proliability, administered by Association Member Benefits Advisors and offered through the Academy, includes coverage for telehealth services.
  • Cybersecurity and Data Breach Protection: Ensure you have adequate coverage for cyber and data breaches, as telehealth services can increase exposure to these risks.
• Understand Telehealth Regulations and Payer Policies
  • Review state specific laws for private payers and Medicaid.
    • There are often specific rules that govern out of state providers intending to provide telehealth services to Medicaid beneficiaries. Contact your state department of health, state dietetics board, or state medical association for the most current information available in your state.
  • Familiarize yourself with payer telehealth policies.
• Know the difference between Payment Parity versus Service Parity:
  • Payment parity refers to regulation or practices ensuring that providers receive equal compensation for services delivered through telehealth as they would for equivalent in-person care. Medicare pays for MNT provided via telehealth at the same rate as in-person visits. Clarify rates with private payers and Medicaid as depending on any applicable state laws they may or may not pay for telehealth services at the same rate as an in-person encounter.
  • Service parity are laws or policies that ensure the scope and quality of health care services delivered through telehealth are equivalent to those provided in traditional in-person settings. It seeks to maintain consistent standards of care, encompassing both the range of services offered and their effectiveness, regardless of the mode of delivery.
  • For more information on state parity laws, refer to the Center for Connected Health Policy.
• Review state-specific licensure requirements for providing MNT remotely.
  • In-State Licensure: If licensed in the state where the patient is located, no further licensure is needed.
  • Out-of-State Licensure: If not licensed in the patient’s state, you may need to become licensed or seek an exemption.

Telehealth Platform/Vendor Selection

• Compliance and Security: Providers are responsible for using communications technology that complies with all state and federal regulations including the Health Insurance Portability and Accountability Act as well as payer requirements and policies.
  • Choose platforms that comply with HIPAA and provide secure, end to end encrypted communications.
  • Ensure the platform can sign a Business Associate Agreement (BAA) to comply with HIPAA.
• Consider Platform Features:
  • Look for user-friendly interfaces, integration with existing EHRs, and the ability to share documents.
  • Ensure accessibility across different devices (PCs, mobile, Apple, Android).
  • Assess the pricing structure (monthly rates, per-visit fees) and available tech support.
    • Consider if support is available 24/7 versus only at certain times, or if support is available "on demand" rather than a support ticket system.

Workflow

• Appointments and Documentation:
  • Review and develop consistent processes for both in-person and telehealth visits (registration, consent, documentation, billing, delivery of patient resources, etc.).
    • Remember to document the service as being delivered via telehealth and note all individuals present even if they are off screen or just observing.
  • Secure consent for telehealth services and verify coverage with insurers.
    • Clarify patient co-payments and cost-sharing for MNT or any other services you provide via telehealth.
    • Billing instructions may differ (with the same insurance company) based on the type of individual plan a patient has (commercial, self-funded, Medicare Advantage, or other type). Clarifying billing instructions for services provided via telehealth can help to ensure accurate payments.
• Consider both the Provider and Patient Experiences:
  • Provide guidance for clients to set up their technology for telehealth appointments to avoid disruptions.
  • Perform "tech checks" to ensure smooth consultations.
  • Identify and set up a quiet and professional space to use for your telehealth appointments, taking into consideration what your patients/clients will see from their perspective.
  • Consider employing multiple monitors for easier documentation.

Collect data

If you're collecting data on MNT outcomes through both in-person and telehealth services, consider organizing and analyzing the data by delivery modality to inform contract negotiations.

Academy members can access ANDHII, for free to track nutrition care outcomes and contribute to advancing evidence-based practice and research.