Master the upcoming ICD-10 code and IPPS changes! Prepare your team for the upcoming changes taking effect on October 1. Discover the benefits of IPPSPalooza and how it can drive your success. Click here >

Telehealth, as in Real Estate, it’s Location, Location, Location

Telehealth, as in Real Estate, it’s Location, Location, Location

The spike in telehealth usage during the COVID pandemic has generated a plethora of questions about the ramifications of geography. Let’s cover a few.

First, as I mentioned in a prior article, Medicare applies a geographic adjuster. That means that if you’re supposed to bill using the locality of where the physician is sitting, it’s possible to do geographic arbitrage: plunking your physician in the highest-reimbursed area.

I’m not recommending that. In fact, it’s part of my argument that the location of the physician shouldn’t matter. And I want to remind folks that there’s no statute or regulation explicitly requiring billing where the physician sits. To be clear, there is also no statute or regulation specifically supporting my position. But first, when there is no specific law, it is hard to argue that any course of action is illegal. Moreover, billing where the patient is makes the most sense.

But billing is far from the only factor we need to consider regarding any telehealth service. I think that most people are attuned to the various licensure issues that can arise. There’s absolutely no doubt that in most situations, the physician should be licensed both in the location where he or she is usually practicing and in the state where the patient is usually located. The word “usually” there is important. When either the patient or the physician is on vacation for a few days in a particular state, the risk that anyone insists licensure is required is low. In addition, if the telehealth visits are ancillary to an in-person visit, whereby the patient travels to the clinic, there is a reasonable argument that the physician needn’t be licensed in the state where the patient is. But I should mention that there is always a small risk that a state would take the position that a license is required. I believe it was Kansas that tried to insist that physicians treating patients in a plane flying over the state should be licensed there. I can’t swear that the state was Kansas, and the incident happened in the early 1990s. That horror story doesn’t change the fact that from a practical perspective, the risk associated with a visit of a couple of days is low.

But licensure isn’t the only worry. There’s a more overlooked and probably more significant concern: medical malpractice. Some medical malpractice insurers will attempt to deny coverage for some telehealth visits. Frankly, the slap on the wrist you’re likely to get from a board complaint will feel like a sweet caress compared to the consequences if the insurer attempts to dodge coverage of a malpractice claim. Understanding reimbursement and licensure are important, but understanding medical malpractice is vital.

I will acknowledge that some of my advice isn’t intellectually consistent. While I generally recommend billing where the patient is and not where the physician is, if the physician is outside the United States, I’m a bit more worried about Medicare’s position that services outside the U.S. aren’t covered. Since I’m asserting that the service occurs wherever the patient is, the physician’s presence in Paris shouldn’t matter. I worry about it nevertheless. But if your compliance team is reaching out to your physicians when they are somewhere domestic and singing the beautiful Moody Blues song “I Know You’re Out There Somewhere,” I think you can change the tune to Frankie Goes to Hollywood and tell them to “Relax.”

Going back to the blues, I will admit that the times I’ve been mistaken are impossible to say, but I don’t think this is one of them. 

Programming note: Listen every Monday for Healthcare attorney David Glaser’s “Risky Business” segment on Monitor Mondays with Chuck Buck, 10 Eastern.

Print Friendly, PDF & Email
Facebook
Twitter
LinkedIn
Email
Print

David M. Glaser, Esq.

David M. Glaser is a shareholder in Fredrikson & Byron's Health Law Group. David assists clinics, hospitals, and other health care entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David's goal is to explain the government's enforcement position, and to analyze whether this position is supported by the law or represents government overreaching. David is a member of the RACmonitor editorial board and is a popular guest on Monitor Mondays.

Related Stories

Leave a Reply

Please log in to your account to comment on this article.

Featured Webcasts

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

Mastering the Two-Midnight Rule: Keys to Navigating Short-Stay Admissions with Confidence

The CMS Two-Midnight Rule and short-stay audits are here to stay, impacting inpatient and outpatient admissions, ASC procedures, and Medicare Parts C & D. New for 2024, the Two-Midnight Rule applies to Medicare Advantage patients, requiring differentiation between Medicare plans affecting Case Managers, Utilization Review, and operational processes and knowledge of a vital distinction between these patients that influences post-discharge medical reviews and compliance risk. Join Michael G. Calahan for a comprehensive webcast covering federal laws for all admission processes. Gain the knowledge needed to navigate audits effectively and optimize patient access points, personnel, and compliance strategies. Learn Two-Midnight Rule essentials, Medicare Advantage implications, and compliance best practices. Discover operational insights for short-stay admissions, outpatient observation, and the ever-changing Inpatient-Only Listing.

Print Friendly, PDF & Email
September 19, 2023
Secondary Diagnosis Coding: A Deep Dive into Guidelines and Best Practices

Secondary Diagnosis Coding: A Deep Dive into Guidelines and Best Practices

Explore comprehensive guidelines and best practices for secondary diagnosis coding in our illuminating webcast. Delve into the intricacies of accurately assigning secondary diagnosis codes to ensure precise medical documentation. Learn how to navigate complex scenarios and adhere to coding regulations while enhancing coding proficiency. Our expert-led webcast covers essential insights, including documentation requirements, sequencing strategies, and industry updates. Elevate your coding skills and stay current with the latest coding advancements so you can determine the correct DRG assignment to optimize reimbursement, support medical decision-making, and maintain compliance.

Print Friendly, PDF & Email
September 20, 2023
Principal Diagnosis Coding: Mastering Selection and Sequencing

Principal Diagnosis Coding: Mastering Selection and Sequencing

Enhance your inpatient coding precision and revenue with Principal Diagnosis Coding: Mastering Selection and Sequencing. Join our expert-led webcast to conquer the challenges of principal diagnosis selection and sequencing. We’ll decode the intricacies of ICD-10-CM guidelines, equipping you with a clear grasp of the rules and the official UHDDS principal diagnosis definition. Uncover the crucial role of coding conventions, master the sequencing of related conditions, and confidently tackle cases with equally valid principal diagnoses.

Print Friendly, PDF & Email
September 14, 2023
2024 IPPS Summit: Final Rule Update with Expert Insights and Analysis

2024 IPPS Summit: Final Rule Update with Expert Insights and Analysis

Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY24 Inpatient Prospective Payment System (IPPS) Final Rule, including new ICD-10-CM/PCS codes, plus insights, analysis and answers to questions from the country’s most respected subject matter experts.

Print Friendly, PDF & Email
2024 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

2024 IPPS Summit Day 3: MS-DRG Shifts and NTAPs

This third session in our 2024 IPPS Summit will feature a review of FY24 changes to the MS-DRG methodology and new technology add-on payments (NTAPs), presented by senior healthcare consultant Laurie Johnson, with bonus insights and analysis from two acclaimed subject matter experts

Print Friendly, PDF & Email
August 17, 2023

Trending News