Introduction
Telemedicine is transforming the healthcare landscape, offering unprecedented access to medical care across state lines. However, with these opportunities come significant compliance challenges, especially around the corporate practice of medicine (CPOM) laws and varying state regulations. To help telemedicine practices maintain regulatory alignment and avoid costly legal pitfalls, we’ve created this 17-point checklist. Whether you’re a startup or an established provider, this guide will ensure your telemedicine practice complies with essential legal and operational requirements.
Table of Contents
- Understanding CPOM Requirements by State
- Physician Licensing Across Multiple States
- Medical PC Ownership Rules
- Collaborative Agreements for Telemedicine Providers
- Telemedicine-Specific Informed Consent
- Ensuring HIPAA Compliance in Digital Health
- Proper Documentation and Record-Keeping
- Credentialing and Payer Enrollment
- Telemedicine Billing and Reimbursement Guidelines
- Prescribing via Telemedicine
- Medical Director Agreements
- Professional Entity Corporate Compliance
- Third-Party Legal Support for Telemedicine
- Data Security and Encryption Requirements
- Telemedicine Accounting Practices
- Review of MSAs and PC Operating Agreements
- Staying Updated with Regulatory Changes
Step 1: Understanding CPOM Requirements by State
Before expanding your telemedicine practice, it’s essential to understand the corporate practice of medicine (CPOM) rules in every state where you plan to operate. CPOM laws vary and can determine whether a physician or non-physician can own a medical practice. Violations can lead to penalties or revocation of licenses.Step 2: Physician Licensing Across Multiple States
If your telemedicine service intends to serve patients across state lines, ensure that all physicians are appropriately licensed in each state where they provide care. Multi-state licensing is crucial to avoid unauthorized practice of medicine.Step 3: Medical PC Ownership Rules
Determine the appropriate structure for your practice based on local CPOM laws. In some states, non-physicians cannot own a medical practice, making physician ownership or a Professional Corporation (PC) necessary.Step 4: Collaborative Agreements for Telemedicine Providers
When employing Advanced Practice Providers (APPs) like nurse practitioners, telemedicine providers must have collaborative agreements to comply with state regulations on supervision and collaboration.Step 5: Telemedicine-Specific Informed Consent
Ensure that patients are provided with telemedicine-specific informed consent forms that meet state guidelines and clearly explain the risks and limitations of telemedicine.Step 6: Ensuring HIPAA Compliance in Digital Health
Telemedicine providers must ensure that all platforms and communication tools meet HIPAA standards for patient privacy and data security. Encryption and secure storage are critical components of HIPAA compliance.Step 7: Proper Documentation and Record-Keeping
Maintaining thorough and compliant documentation is critical for telemedicine practices. This includes detailed patient records, consent forms, and any communications related to the patient’s care.Step 8: Credentialing and Payer Enrollment
Verify that your telemedicine practice has completed the necessary credentialing and payer enrollment processes to avoid issues with reimbursement. Working with insurance payers requires careful attention to detail.
Step 9: Telemedicine Billing and Reimbursement Guidelines
Understand the specific billing codes and reimbursement rules for telemedicine services, which can differ from in-person care. Failure to follow these guidelines may result in denied claims or delayed payments.Step 10: Prescribing via Telemedicine
Telemedicine providers must comply with state laws governing medication prescribing, mainly controlled substances. The Ryan Haight Act and state-specific rules must be adhered to for prescribing practices.Step 11: Medical Director Agreements
Ensure that your telemedicine practice has a compliant medical director agreement to manage clinical operations and maintain oversight, as state regulations require.Step 12: Professional Entity Corporate Compliance
Telemedicine practices structured as professional corporations must ensure ongoing corporate compliance with state laws. This includes filing annual reports, maintaining proper tax filings, and renewing licenses.Step 13: Third-Party Legal Support for Telemedicine
Engage third-party legal experts familiar with telemedicine laws to assist with compliance issues, contract review, and guidance on regulatory changes. Staying proactive can help avoid costly legal battles.Step 14: Data Security and Encryption Requirements
Telemedicine practices must implement robust data encryption protocols and cybersecurity measures to protect sensitive patient data. This includes using secure platforms for video consultations and record-keeping.Step 15: Telemedicine Accounting Practices
Ensure that your accounting practices align with telemedicine operations, including tracking telemedicine-specific billing codes and managing insurer reimbursements.Step 16: Review of MSAs and PC Operating Agreements
Regularly review and update your Management Services Agreements (MSAs) and PC operating agreements to ensure they comply with the latest state and federal regulations.Step 17: Staying Updated with Regulatory Changes
Telemedicine laws and regulations are constantly evolving. It’s essential to stay informed about updates in telemedicine compliance and adapt your practices accordingly.
Breaking It Down
Telemedicine presents incredible opportunities for expanding patient care but ensuring compliance is critical to long-term success. With this 17-point checklist, your practice can confidently navigate the complexities of telemedicine regulation while focusing on delivering high-quality, compliant care. ProMed Preferred supports your compliance needs across all 50 states if you have any questions or need further assistance.
Frequently Asked Questions
What is the corporate practice of medicine (CPOM), and why is it essential for telemedicine providers?
The corporate practice of medicine (CPOM) refers to laws that regulate who can own and control medical practices. These laws ensure that only licensed physicians, not corporate entities or non-physicians, make medical decisions. For telemedicine providers, adhering to CPOM laws is crucial to avoid legal penalties and maintain patient care integrity.
How can a telemedicine practice handle multi-state operations while staying compliant?
Telemedicine practices operating in multiple states must ensure that their physicians are licensed in each state where patients are treated. Additionally, they must understand and adhere to varying state laws regarding medical practice ownership, patient consent, and prescribing, as these can differ significantly.
Are there specific telemedicine software or platforms that help with compliance?
Yes, many telemedicine platforms are designed with compliance in mind. These platforms often include features like HIPAA-compliant video conferencing, secure messaging, encryption for patient data, and built-in consent forms. Always verify that the platform meets the specific legal requirements of the states where you operate.
What role do Medical Services Agreements (MSAs) play in telemedicine compliance?
MSAs outline the relationship between a Professional Corporation (PC) and a Management Services Organization (MSO), often defining who is responsible for administrative and non-clinical operations. A properly drafted and compliant MSA ensures that the PC maintains control over medical decisions while the MSO handles business functions, keeping the practice aligned with CPOM regulations.
Can telemedicine providers prescribe controlled substances across state lines?
Prescribing controlled substances via telemedicine is tightly regulated by both federal and state laws, particularly under the Ryan Haight Act. Providers generally cannot prescribe controlled substances unless the patient has been physically examined, though there are some exceptions, especially during public health emergencies. Providers must also ensure compliance with each state’s prescribing laws.
What are the penalties for non-compliance with telemedicine regulations?
Non-compliance with telemedicine regulations can lead to penalties, including fines, legal action, suspension or revocation of medical licenses, and exclusion from reimbursement by Medicare and Medicaid. It can also damage the practice’s reputation, making it essential to stay compliant.
How often should a telemedicine practice review its compliance policies?
Telemedicine practices should review their compliance policies regularly, ideally at least once a year or during significant legal or regulatory updates. Given the fast-evolving nature of telemedicine laws, staying proactive in reviewing MSAs, licensing, and data security protocols is essential for avoiding compliance issues.
How can telemedicine practices ensure HIPAA compliance in their communications with patients?
To ensure HIPAA compliance, telemedicine providers should use secure, encrypted platforms for all communications, including video consultations, messaging, and document sharing. They should also avoid using non-HIPAA-compliant services like regular email or SMS and ensure that staff are trained on best practices for handling patient information securely.
Is malpractice insurance different for telemedicine providers?
While malpractice insurance requirements are generally the same for telemedicine providers as for in-person practices, confirming that your policy covers telemedicine services and interstate care is essential. Telemedicine providers should work closely with their insurance carriers to ensure they have appropriate coverage for all the states in which they operate.
What are the best practices for documenting patient interactions in telemedicine?
Telemedicine providers should document patient interactions as thoroughly as they would for in-person visits. This includes maintaining detailed notes of the consultation, patient consent forms, any diagnoses made, and prescriptions issued. Records should be securely stored and accessible for future reference, and they must comply with HIPAA and state laws.
Do telemedicine providers need to register with state medical boards?
Telemedicine providers often must register with state medical boards and obtain state-specific licenses. Some states have specific telemedicine registration requirements or waivers that streamline the licensing process for providers practicing across multiple states.
What should telemedicine providers know about reimbursement from private insurers?
Reimbursement policies for telemedicine services vary between private insurers, so providers should confirm that their services are covered and submit claims using the correct telemedicine billing codes. Some insurers may require specific telemedicine consent documentation or only reimburse for certain types of virtual consultations.
How does telemedicine compliance differ for international patients?
Telemedicine compliance becomes more complex when treating international patients, as providers must adhere to both U.S. laws and the regulations of the patient’s home country. Additionally, the legal landscape for prescribing and data privacy may differ internationally, so seeking legal counsel is essential before expanding services to other countries.
What kind of legal support should a telemedicine practice have?
Telemedicine practices should work with legal experts specializing in healthcare and telemedicine laws. This ensures that all contracts, including MSAs and collaborative agreements, are appropriately structured and helps the practice stay current with the evolving telemedicine regulations.
Glossary
Corporate Practice of Medicine (CPOM)
Laws that regulate who can own and control medical practices, typically restricting ownership to licensed physicians. These laws are designed to prevent non-medical entities from influencing medical decision-making.
Telemedicine
The practice of delivering medical care and consultation remotely using telecommunications technology, such as video conferencing, secure messaging, and digital platforms.
Professional Corporation (PC)
A type of legal entity created to allow licensed professionals, such as physicians, to operate a business while adhering to the state-specific corporate practice of medicine laws.
Management Services Agreement (MSA)
A contract between a professional corporation (PC) and a management services organization (MSO) that outlines the business relationship and delegations of responsibility, such as administration, billing, and non-clinical operations.
Multi-State Licensing
The process by which healthcare providers obtain medical licenses in multiple states to offer services, particularly telemedicine, across state lines. Each state has its licensing requirements.
Collaborative Agreement
Some states require a formal agreement between physicians and advanced practice providers (APPs), such as nurse practitioners or physician assistants, to ensure proper supervision and collaboration in patient care.
HIPAA
The Health Insurance Portability and Accountability Act of 1996 is a federal law designed to protect sensitive patient information. HIPAA sets standards for the secure handling, transmitting, and storing of health data.
Informed Consent
A process by which healthcare providers disclose information to patients about the risks and benefits of treatment. In telemedicine, informed consent typically includes the unique risks associated with virtual care.
Billing Compliance
Ensuring that the billing practices of a healthcare provider, including telemedicine, are aligned with applicable regulations and guidelines to prevent fraud or improper reimbursement claims.
Reimbursement
The process by which healthcare providers receive payment from insurance companies or government programs (e.g., Medicare) for the medical services they provide. Telemedicine reimbursement often requires specific billing codes.
Ryan Haight Act
A U.S. federal law that regulates the prescribing of controlled substances via telemedicine. The act requires a patient to have an in-person medical evaluation before receiving such prescriptions, with some exceptions.
Medical Director Agreement
A contract that outlines the responsibilities and oversight duties of a medical director in a healthcare practice, ensuring that clinical operations comply with applicable medical and legal standards.
Credentialing
The process by which healthcare providers, including telemedicine practitioners, are evaluated and approved by insurance companies or healthcare organizations to ensure they meet professional standards for delivering care.
Data Encryption
A security measure that converts sensitive patient information into code to prevent unauthorized access. Telemedicine providers must use encryption to comply with HIPAA and other privacy laws.
Medical Services Organization (MSO)
An entity that provides non-clinical services to a medical practice, such as billing, human resources, and administration, often through a Management Services Agreement (MSA) with a professional corporation (PC).
Telemedicine-Specific Billing Codes
A set of codes used in medical billing that are designated explicitly for telemedicine services. These codes allow insurers to process and reimburse for virtual consultations and treatments correctly.
Annual Reports
Legally required documents that a professional corporation (PC) or medical business must file with state agencies to maintain good standing, often including financial statements and corporate compliance status.
Prescribing Regulations
Laws and rules govern healthcare providers’ ability to prescribe medication, particularly in the context of telemedicine. Regulations vary by state and include specific provisions for controlled substances.
Third-Party Legal Support
Law firms or specialists provide external legal assistance to help healthcare businesses navigate compliance, draft contracts, and stay updated with regulatory changes related to telemedicine.
Cybersecurity
The practices and technologies used to protect digital systems, networks, and patient information from cyber threats. Telemedicine practices must implement strong cybersecurity measures to meet legal and regulatory requirements.
Additional Resources for You
American Telemedicine Association (ATA): The ATA is a leading organization that works to promote telemedicine and connected health. Their site offers valuable resources, best practices, and updates on telemedicine laws and policies.
Visit the American Telemedicine Association
HealthIT.gov: This is a comprehensive resource provided by the U.S. government that focuses on health information technology, including telemedicine compliance, electronic health records (EHR), and HIPAA.
Visit HealthIT.gov
Telehealth.HHS.gov: Managed by the U.S. Department of Health and Human Services, this site offers guidance on telehealth laws, billing, and reimbursement, along with tools to support healthcare providers in expanding telemedicine services.
Visit Telehealth.HHS.gov
Federation of State Medical Boards (FSMB): FSMB provides up-to-date information on licensing across multiple states, including telemedicine regulations and physician credentialing.
Visit the Federation of State Medical Boards
Center for Connected Health Policy (CCHP): CCHP is a national telehealth policy resource center that tracks telemedicine laws, reimbursement policies, and state regulatory changes.
Visit the Center for Connected Health Policy
HIPAA Journal: This resource provides the latest news and updates related to HIPAA compliance, data privacy, and healthcare cybersecurity, which are critical for telemedicine practices.
Visit HIPAA Journal
American Medical Association (AMA): The AMA offers resources for physicians navigating the challenges of telemedicine, including CPOM, patient consent, and billing practices.
Visit the American Medical Association
What’s Next?
Ready to ensure your telemedicine practice is fully compliant and aligned with the latest regulations? Take the next step with ProMed Preferred by registering for free today! Our expert team will help you navigate the complexities of telemedicine compliance, from physician ownership to CPOM laws and beyond. Register now and let us provide the support you need to grow your practice while staying compliant in all 50 states.
