UPDATE: As of March 17, 2020, CMS has implemented temporary measures that allow greater use and reimbursement of telehealth for rehab therapists. Read more here.
Telehealth is no passing fad. In fact, more and more PTs are getting wise to the benefits of implementing telehealth technology in their practices—including better access to homebound and rural patients, increased revenue opportunities, and decreased provider costs. Of course, as with any new modality or technology, it’s important to understand the compliance implications of telehealth before offering it as an option to patients. With that in mind, here are four compliance considerations every physical therapist should know about telehealth services:
1. Medicare does not reimburse PTs for telehealth services.
As of 2019, Medicare does not consider physical therapists eligible telehealth providers. Unfortunately, this means Medicare will not reimburse PTs for any telehealth services they provide—even if their state practice act allows it. That said, there may be hope on the horizon: the CONNECT for Health Act of 2019 (which seeks to expand Medicare’s telehealth coverage to physical therapy services) currently sits before Congress and has the endorsement of more than 120 industry leaders and associations. But until legislation passes, PTs and their Medicare patients will have to keep sitting tight.
Medicaid does reimburse PTs for telehealth services—in some states.
Now, for some good news: In nine states, PTs can bill Medicaid for any telehealth services they provide. According to this APTA resource, a 2019 summary of state telehealth policies from the Center for Connected Healthcare Policy listed the following states as explicitly reimbursing for telehealth (aka, telerehab) services:
- New York
The same resource also listed the following 11 states as having language in their state practice acts that may allow for Medicaid to reimburse for telerehab services, although it’s not explicitly stated:
- New Mexico
- North Dakota
- Rhode Island
Some commercial payers reimburse for telehealth services.
If you plan on providing telehealth services to patients with non-federal or non-state payers, you’ll need to make sure your payer contracts include language endorsing it. Additionally, as this APTA resource mentions, be sure to confirm:
- “whether the originating site can be a private home or office,
- if services must be real-time or can be asynchronous, and
- any other limitations to your use of telerehab.”
2. PTs may only provide services to an out-of-state patient if the provider and patient are in licensure compact states.
Expansion of the physical therapy licensure compact—which “allows eligible licensed physical therapists to practice and licensed physical therapist assistants to work in a Compact member state, other than their home state, without going through the usual process for licensure in the remote state”—opens up a massive opportunity for physical therapists who adopt telehealth in their practice, as they can offer this service to patients in other states (as long as the patient is located in another licensure compact state).
As of 2019, 26 states are part of the state licensure compact, but not all have begun issuing or accepting compact privileges. You can check the status of your state here.
3. Your telehealth vendor must be HIPAA-compliant.
According to this resource from APTA, contracts with telehealth software vendors “must state how the vendor is permitted and required to use PHI and that the vendor will not use or disclose PHI outside those parameters, as well as requirements for appropriate safeguards to prevent misuse of PHI.” In other words, you must ensure your vendor adheres to all HIPAA requirements. After all, the financial penalties for noncompliance can be as much as $50,000 per violation.
It’s up to you to ensure your vendor is HIPAA-compliant, so be sure to do your due diligence by asking the right questions prior to purchasing. Some questions to keep in mind are:
- Does the software vendor claim to be HIPAA-compliant?
- What safeguards does the software have in place?
- Does the vendor store the transmitted information or any PHI?
For more information on how to mitigate HIPAA risk for your third-party business associates, check out this blog post by WebPT compliance expert Veda Collmer.
4. You may need to obtain patient consent.
If your state allows you to provide telehealth services—and you’re chomping at the bit to get started—you better verify whether or not you need to obtain the patient’s consent before providing those services. While some states require only verbal consent, others require written consent. For that reason, it’s crucial that you check your state practice act or consult with your legal advisor before moving full-steam ahead. You can also verify your state’s requirements by using The National Health Policy Resource Center’s state map. Still, even if your state doesn’t require patient consent, it’s best practice to obtain it anyway.
Hopefully, these facts will help you decide whether adding telehealth services is the right move for your clinic. If you’re ready to move forward—and you’d like a comprehensive guide to help you get the ball rolling—click here and download our free revenue diversification guide to start boosting your practice’s revenue with telerehab and other innovative services ASAP.