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Telehealth Guidelines For Providers And Telemedicine Requirements

Posted on by Nathan Cron

Access to Telehealth appointments has become more essential than ever in light of the COVID-19 public health pandemic. This pandemic highlighted many of the flaws in the public health system, with the accessibility and effectiveness of Telehealth being one of the most significant. 

Telehealth is a wide topic that includes online communication with patients and storing patient data in a secure online portal that the patient can access in addition to phone and video appointments in lieu of having the patient physically visit the office. 

Great strides have been made in Telehealth in the past two years, and there are now several ways that providers can offer these invaluable services to their patients. 

Telehealth Services For Patients

For patients, Telehealth services can provide several benefits including but not limited to:

  • Extended access to care beyond normal business hours
  • Reducing the time and cost of transportation 
  • Provide better care to rural and underserved populations
  • Enabling long-term support for patients with chronic and disabling health conditions
  • Easier access to primary screening of symptoms for appropriate referrals
  • Preventing the spread of infectious diseases by keeping the patient at home

While it is not appropriate in every situation, Telehealth has quickly become an efficient and effective method of providing care to the majority of the population.

Telehealth appointments are perfect for patients that are planning to visit the doctor for the following reasons:

  • General wellness visits or yearly checkups
  • Chronic pain management
  • Medication refills for chronic conditions
  • Going over laboratory results or care instructions
  • Going over diagnostic, therapeutic, or alternative treatment options
  • Minor Dermatological concerns
  • Weight loss management and nutrition guidance
  • Mental health care, counseling, and therapy appointments

There are, however, several instances where Telehealth appointments may not be beneficial, or may not provide the appropriate level of diagnostic care. These situations may include:

  • Severe abdominal pain, particularly when localized
  • Concerns with vision or hearing
  • Dental pain or discomfort
  • Situations that require a physical examination such as a tear, sprain, or broken bone
  • Any situation that may require surgical intervention
  • Situations that involve multiple conditions that are interacting with each other
  • Gynecological or Obstetric concerns 

While it is not impossible to diagnose or treat patients in these situations, it is generally in the best interest of the patient to receive in-person care for these conditions when possible. 

For situations where Telehealth is a logical and reasonable method of providing care, there are several methods of offering Telemedicine.

Remote Patient Monitoring

Remote patient monitoring allows patients to remain in the comfort and security of their own homes while still providing essential patient health data to their medical care provider. 

This is achieved through the use of in-home medical monitoring devices such as blood pressure cuffs, glucose monitors, pulse oximeters, pacemakers, weight monitors, and spirometers. These devices capture and monitor patient data regularly throughout the day and then transmit the medical data directly to the providers’ systems. 

This allows providers to continuously monitor their patients’ vitals which enables them to provide accurate and up-to-date treatment options and assessments. In turn, this eliminates unnecessary and often costly trips to the doctor, emergency room and urgent care visits, and hospitalizations for their patients. 

In many situations, remote patient monitoring may also allow for relatively healthy elderly and disabled patients to remain in their own homes for longer without having to be transferred to skilled nursing facilities or retirement communities. 

Remote patient monitoring can be utilized to support both asynchronous and synchronous health care.

Asynchronous Telehealth Care

Asynchronous telehealth care, sometimes referred to as store and forward care, is common in healthcare settings that require imaging, laboratory results, or other diagnostic indicators in order to properly treat a patient. 

In these situations, patient information is obtained at one time and is then forwarded to the physician to review when they have the time to do so. This is beneficial for providers as it eases the strain on their resources and time, and it is beneficial for patients as the provider will have had time to review all of the necessary information before their appointment. 

Asynchronous care can be performed by any provider, but it is most common in the following medical fields:

  • Dermatology
  • Radiology
  • Cosmetic surgery
  • Orthopedics
  • Ophthalmology

Some primary examples of asynchronous telehealth are Xrays or MRI imaging sharing, wound imaging, symptoms surveys, and patient reports sharing.

Synchronous Telehealth Care

Whereas asynchronous telehealth care is performed with pre-gathered data at a later date, synchronous telehealth care takes place in “real-time”. More commonly known as virtual visits, synchronous telehealth care allows for efficient evaluation and acquisition of data directly from the patient and enables immediate communication between patient and provider. 

Synchronous telehealth care often occurs in the form of a video call and is common for:

  • Direct consultations between a primary care provider and a specialist
  • Physical therapy evaluations and subsequent sessions
  • Diagnosing and prescribing treatment for minor to moderate ailments 
  • Behavioral evaluation & therapy sessions
  • Quality of life consultations for patients in hospice

In addition to these benefits, synchronous telehealth care is extremely efficient and beneficial for patients that may not have adequate transportation or monetary resources to see medical specialists.

Finding The Right Telehealth Technology

There are several types of telehealth technology available, and some may be better suited for your practice or the type of care that you wish to provide. The most widely available forms of telehealth include:

  • Live video: A face-to-face interaction between patient and provider over the computer. 
  • e-visits: Visits communicated through an online patient portal (not face-to-face).
  • Store and forward: Evaluation of submitted images or diagnostic aids at a different time than the patient’s appointment. 
  • Audio-only visits: Telephone visits between patient and provider.
  • Remote patient monitoring: Utilizing digital technologies to monitor patient vitals and statistics from a remote location
  • Mobile health (mHealth): Utilizing secure phone applications to allow patients to review their personal health data and submit questions or concerns to their physician via a messaging or email system. 
  • Care-based teleconferencing: Providing interdisciplinary and integrated treatment options to patients, often while including family members in the treatment plan. 

Once you have decided on what type or types of telehealth you want your practice to offer, it is time to identify any technology that may already be available that you are currently using. A phone and internet connection is enough for live, e-Visits, and audio-only visits for example. 

Many providers also already have some version of a patient portal that is used to store test results, imaging, and other items used in the diagnosis and treatment of their patients. These can be easily converted to allow patients access to their information in addition to a messaging feature so that they can ask their provider questions as they come up without having to wait for an appointment.

When researching further options for offering telehealth care, it is important to consider HIPPA guidelines when choosing which video communication services to use. Some other things to consider when deciding upon telehealth technologies and telehealth vendors are:

  • Is a contract required?
  • Does it offer a waiting room feature?
  • Do you need to purchase any special equipment for it to function properly?
  • How will patient consent be obtained? Directly through the patient portal or prior to granting access?
  • Does it offer end-to-end encryption?
  • Does it offer an in-application scheduling feature for both patients and providers?

It is important to consider what your practice’s unique needs are concerning telemedicine technology to ensure that you choose the right vendor. 

Scheduling And Managing Appointments

When you choose to offer telemedicine options to your patients, it is essential to implement a telehealth workflow and protocols to ensure that you and your team do not get overwhelmed by telehealth requests. 

Some of the key things that you should consider before implementing a telehealth system are:

  • When will you offer telehealth appointments? How often will you be available?
  • What type of services will you offer? 
  • How will you offer services to patients that do not speak English? Will you have an interpreter available? 
  • Will your staff schedule appointments or will patients be able to schedule their own? 
  • How can you easily access patient information prior to and during their appointment?
  • Will you have a medical assistant greet the patient and ask the initial questions at the start of the visit? 
  • What options will you provide for patients with visual or hearing-related disabilities? 
  • How can caregivers use the system to facilitate telehealth appointments between you and the patient?
  • How will you collect payment after the visit?
  • How will you obtain the patient’s consent for the visit?
  • Will the patient have access to their medical records via an application or a patient portal during and after the visit?

In addition to these basic considerations, it is also important to ensure that your patients know about the availability of telehealth appointments as well as how to use the necessary technology to participate in these appointments. 

It can be beneficial to send an email or a text message to the patient after their appointment has been created detailing any necessary instructions on accessing the telehealth portal at the time of their appointment. 

If an application or certain website needs to be accessed for the appointment, it will help both the patient and the provider if that information is sent ahead of the appointment with instructions. This will give the patients time to familiarize themselves with the process so that there are fewer technical issues on the day of the appointment. 

Finally, it is important to ensure that your staff is familiar with the technology as well as the protocols in place. Conduct a training session with the new equipment and software, and encourage them to use the system to gain familiarity with it. It may also be beneficial to have a FAQ sheet available for them should they have any questions. 

Preparing To Visit A Patient

When preparing to conduct a telehealth visit with a patient make sure that you are in a private room and that you have placed a sign on the door to not be disturbed. From here, ensure that your equipment is working properly and that you have the patient’s information readily available before the appointment begins. 

If the patient is new, introduce yourself and greet the patient, then confirm the patient’s identity by having them show you their driver’s license or another form of identification. Determine if the patient’s consent has already been given for the visit and if not obtain their consent at the beginning of the appointment.

At this time, you should also verify that the patient is alone, or that if anyone is in the room with them, such as a caregiver or family member, that the patient has given their consent for them to remain. Ensure that the patient feels comfortable with the visit and that all of their questions about privacy and security have been answered. 

Finally, before the clinical portion of the visit begins, ensure that you have a good phone number to reconnect with the patient in the event that either side loses internet connectivity or the call drops during the visit. This will allow you as the provider to reach out immediately after the patient has been disconnected to finish the visit. 

Visiting A Patient And Following Up 

Once the patient’s information has been verified and both parties are confident that their connection is secure, it is time to begin the actual telehealth visit. 

First, confirm that the patient’s health history is up-to-date and that there have not been any major new medical events that have taken place, such as a trip to the emergency room. 

From here, if possible, attempt to get any vitals for the patient that you can. Use any technology that the patient has on hand that they are comfortable using. For example, if the patient has a smartwatch or Fitbit then they can provide you with a pulse reading. The same applies if they have access to a blood pressure cuff. This will be more common if the patient has a caregiver. 

Another useful and readily available vital should be the patient’s weight. Once you have obtained as many vitals as possible, document everything that the patient was able to provide as well as the information that they couldn’t for insurance purposes Then it is time to move on to the subject of the visit.

Ensure that you are taking your time with the patient and answering all of their questions just as you would during an in-person visit. It is especially important to pay attention to the patient’s verbal cues and body language in addition to what they are saying to ensure that you are not missing any information that you would catch in an in-person conversation. 

Ask them to describe any symptoms that they are having in detail and ask probing questions to get as much information as possible that can help with a diagnosis or treatment decision. 

At the end of the appointment, let the patient know that they can email or message you with any questions or concerns that they may have forgotten to bring up. After the appointment, provide any necessary referrals, submit prescriptions to their pharmacy, and send the patient any follow-up care instructions that are necessary.

Making Telehealth Accessible

It is important to ensure that the majority of your patients have reasonable access to the telehealth options that you are offering. It can be beneficial to announce that you are going to start offering telehealth options in the future. 

By announcing your plans for telehealth ahead of time, you will not only allow your patients to get accustomed to the idea, but it will also give them time to familiarize themselves with the options that will be available to them. 

Consider sending an email to your current patients to inform them of the anticipated date that telehealth services will be available and update your website to reflect the change that will be coming. It is always better to keep your patients in the loop instead of surprising them with drastic changes to the way that your office operates. 

The Barriers To Telehealth

There are several potential barriers to a patient’s ability to access telehealth services. These include the lack of interpreters for patients that do not speak English, lack of access to accessibility devices that can help patients that are hard of hearing or have vision problems, and a communication barrier for patients with speech difficulties. 

All of these concerns can be worsened when attempting to engage a patient with unique needs in a telehealth setting. 

Per the Americans with Disabilities Act, a provider that is offering telehealth services must be ready and able to accommodate patients with disabilities by offering the services of a qualified notetaker, qualified reader, qualified sign language interpreter, or any equal level of accommodation that will allow the patient and provider to correctly understand each other. 

Providers should also keep in mind the possibility of non-English speakers utilizing the telehealth portals and should be prepared to offer accommodations to them as well. It can be beneficial to have a licensed medical interpreter on staff or on call to conference into video or voice calls to help facilitate communication in these situations. 

Improving Access To Telehealth

The largest and most common barrier to telehealth care is patient access to and availability of the internet. Many rural and remote towns and populations lack access to high-speed internet and the bandwidth that is required to be able to participate in video conferencing. 

Due to their location, these populations also tend to have less access to in-person medical care as well. For many, the nearest doctor, clinic, or hospital may be up to an hour’s drive away. 

Because of this, there has been a recent initiative to improve rural populations’ access to quality healthcare. The Federal Communications Commission Lifeline provides monthly internet services to people with low incomes for a discounted rate, or in some cases, free of charge. 

Some patients may also have access to locations such as public libraries or fast food restaurants that provide access to public Wi-Fi. This may be an option for patients that need a telehealth appointment, but it is important to remind patients to not enter any personal or sensitive information onto any website while on public Wi-FI.

In certain situations, access to video conferencing for telehealth may not be available. In these cases, ensure that your office is equipped to perform voice-only calls to help these patients. 

Lab Work

In the majority of cases, physicians should be able to order the blood work that their patients require during or after a telehealth visit. The laboratory of your choice, or the patient’s choice, should be able to receive the request digitally, but it is also a good practice to send the patient a laboratory requisition form as well.

This enables the patient to go to the lab of their choice when it is convenient for them or to have a service such as the National Phlebotomy Provider Network come to the patient to have their lab work drawn. 

Transitioning To Telehealth

Making the transition to offering telehealth services is a time-consuming, intensive, and potentially expensive process. There is no doubt that telehealth services are more important and essential now than they ever have been, however. 

At the beginning of the COVID-19 pandemic, healthcare providers were unable to meet the sudden demand that was placed upon them, and it took months before adequate changes were implemented as the new standard. Among these changes was a new emphasis on the widespread availability of remote patient care, or telehealth medicine. 

This new need and expectance of accessible healthcare is here to stay. This means that providers who do not currently provide some form of telehealth care are now the minority and it is time to make the transition. 

Throughout the transition process, it is essential to keep your patients informed of any changes that will be made to your existing practice, such as the way appointments are scheduled or how lab results will be available to them. 

Not only will this help to smooth the transition process, but it will also give you the opportunity to get feedback from your patients and staff members about new protocols and programs. When possible, keep an open mind to this feedback and take note of any things that you may have not considered or overlooked. 

Patient Consent

Just as with an in-person examination, getting the patient’s consent to be treated is mandatory in telehealth visits. At the beginning of the appointment, explain to the patient how the telehealth visit will go, what they can expect from the visit, and what their rights are. 

In most cases, getting verbal consent from the patient to proceed with the telehealth visit is sufficient. Be aware of any other people that may be in the room with the patient or in the room with you during the call, and inform the patient of these people. Before proceeding with the visit, ensure that you have the patient’s consent to include these other parties in the visit. 

Consult with your legal team for more in-depth recommendations regarding a patient’s consent to treatment. When possible, it is also advisable to obtain written permission from the patient prior to the appointment as well as verbal consent during the appointment. 

Introducing Patients To The Technology

The transition to telehealth will undoubtedly be challenging for your patients as well. As telemedicine is still a relatively new method of care, it is likely that your patients will have questions about it. 

These are some of the subjects that you should consider discussing with your patients or that you should include information on on your website.

  • What types of care do you offer through telehealth?
  • Are there any conditions that you cannot treat through telehealth?
  • When should a patient choose a telehealth appointment over an in-person appointment?
  • What types of telehealth do you offer? Phone calls, video calls, text messaging, mobile app support, remote monitoring, etc.
  • How is a telehealth appointment different from an in-person appointment?
  • What security measures do you have in place to protect your patients’ information?
  • Is there an additional cost associated with a telehealth appointment? 
  • Will the patients’ insurance cover a telehealth appointment?
  • What days/times do you offer telehealth appointments?
  • How can a patient make a telehealth appointment?
  • What equipment or technology does your patient need in order to have a telehealth visit?
  • Do you offer interpreters for non-English speakers?
  • What accommodations do you offer for patients with disabilities during a telehealth visit?

In addition to addressing all of these questions, it is beneficial to emphasize the benefits that telemedicine can offer, particularly to patients in vulnerable populations such as the elderly. Some of these benefits include:

  • Limiting physical contact which can limit the spread of infectious diseases such as the flu and COVID-19
  • Saves time and money on arranging transportation to travel to and from the doctor’s office – appointments can be done in the comfort of the patient’s home
  • Reduces the need to get time off to travel for an appointment, in many cases telehealth appointments can be done during lunch periods or other downtimes
  • Allows the provider to see more patients in the same amount of time
  • Allows rural populations access to specialists that they may not otherwise be able to see
  • Allows for appointments without having to arrange for child-care or elder-care 
  • Eliminates the time spent waiting in a waiting room – simply log on when it is your appointment time

The important thing to help patients understand is that a telehealth appointment will proceed exactly the same as an in-person appointment. The only difference is that telehealth is more convenient and accessible to both the patient and the provider in most situations. 

Let the patient know that they should feel comfortable asking questions and that they can decide to stop the telehealth visit at any time if they feel uncomfortable or if they decide that they would prefer an in-person appointment instead.

Your Patients First Appointment

Prior to your patient’s first appointment, ensure that they have all of the information that they need to make the visit a success. Send them an email detailing any equipment or technology that they will need for their appointment. Then, include a number or email address that they can reach out to if they need help troubleshooting. 

In the pre-appointment instructions, you should also include any information that you will need from the patient as well as any forms that should be filled out and returned to your office before the day of the appointment. 

Finally, make sure that the patient has all of the necessary log-on information that they will need for the visit, and inform them of any calls that your staff may make immediately before the visit. 

Once you and your patient begin the telehealth visit, explain to them what will happen in the visit and ask the patient if they have any questions or expectations. Check to see if there is anyone else in the room with the patient, and if there is either ask the person to leave or get verbal consent from the patient to allow them to stay. 

At the beginning of the visit, it is important to get consent from the patient for the visit and to obtain a phone number that you can call them back at should you get disconnected. Then, obtain the patient’s medical history if you do not already have it and proceed through the appointment as normal. 

Telehealth Licensing

Each state has unique licensing requirements in regard to telemedicine. For the most up-to-date requirements for each state, see the following:

U.S. States and Territories Modifying Requirements for Telehealth in Response to COVID-19 – from the Federation of State Medical Boards updated May 31, 2022

U.S. States and Territories Modifying Licensure Requirements for Physicians in Response to COVID-19 – from the Federation of State Medical Boards updated May 31, 2022

COVID-19 Related State Actions – from the National Policy Center – Center for Connected Health Policy

Provider Bridge – A directory of resources for providers

Licensing Resources for Social Workers 

Licensing Resources for Occupational Therapists

Substance Abuse and Mental Health Services Administration (SAMHSA) COVID-19 Resources

HRSA Rural FQHC Telebehavioral Health Guidelines

HRSA Telehealth Resource Center

Medicare And Medicaid Policies

Medicare and Medicaid policies on telemedicine frequently change as new technology is presented and new research is done that proves that telehealth can be just as effective as in-person visits. 

It is recommended that your practice regularly review the newest additions and addendums to Medicare and Medicaid policy to ensure that you are billing correctly so that your practice’s claims are approved. 

Medicare

During the COVID-19 public health epidemic, both Medicare and Medicaid policies were significantly loosened to allow more people to seek healthcare in any form available, including telehealth care. 

Legislation was passed for Medicare that requires 151 days to pass after the end of the COVID-19 public health epidemic before any new legislation or policies can be passed that contradicts or end the current policy. 

In addition to this requirement, there were several other changes to Medicare coverage, reimbursement, and telehealth policies including:

  • Began paying for virtual check-ins
  • Expanded payment and reimbursement for telehealth
  • Began paying for several telemedicine services including:
    • Emergency department visits
    • Initial inpatient and nursing facilities visits
    • Discharge day management services
    • Certain services delivered to patients at home
  • Began paying for group psychotherapy
  • Began paying for psychological and neurological testing
  • Began paying for lower-level rest home or custodial care services
  • Began paying for cognitive assessments
  • Began paying for care planning services
  • Began paying for prolonged services
  • No more geographical restrictions for patients or providers
  • All providers that are eligible to obtain Medicare reimbursement may bill for the above
  • Providers can reduce or wave cost-sharing for telemedicine visits
  • Issued a waiver to allow the use of audio-only equipment
  •  Other temporary services

Medicaid

The majority of states have expanded the coverage offered to Medicaid recipients under the expanded policy benefits as a result of the COVID-19 public health epidemic, however exact coverage varies from state to state. 

Most states under the new policy are currently providing coverage for:

  • Store-and-forward (asynchronous) healthcare
  • Telemedicine services
  • Telehealth from the home
  • Telemedicine via email, phone, or video call

Review the current state and local laws and reimbursement policies for more information on permanently covered Medicaid services.

Even during the COVID-19 public health epidemic Medicaid and CHIP coverages can lapse. Luckily, there is information available to help your patients retain coverage during the “unwinding” process including:

Billing

When billing Medicare, Medicaid, and Private Insurance, it is essential to review all documentation and attached diagnostic and billing codes to ensure that the claim will be approved or reimbursed with minimal delay. 

Other important things to consider when documenting your reimbursement request include:

  • Thorough documentation of procedures, diagnoses, and tests
  • Patient consent
  • Proper documentation regarding code categories, ie. for video calls, audio-only calls, etc. 
  • Time of visit. Only document time spent directly with the patient, not time that the clinical staff engaged the patient. 
  • Store-and-forward documentation is unlikely to be reimbursed. For a list of policies in your state regarding this, check here. 

Medicare

A significant number of new Medicare Fee-For-Service services are currently billable as a result of the policy changes in place during the COVID-19 public health epidemic. Telehealth visits are now covered under the same fee schedule as in-person visits. 

While Medicare has drastically increased the number of services that are now covered as a result of the public health epidemic, not all of these services will be permanently covered. 

A list of the codes that will be permanently covered under the Medicare Fee Schedule can be found here. The National Policy Center also has a fact sheet available that details the changes, both temporary and permanent, to telemedicine billing practices. 

Additionally, new allowances have been made for rural health clinics and other federally qualified health clinics to bill Medicare for reimbursement for several covered services. 

Other useful information regarding changes to the way that Medicare is handling billing, payments, and reimbursement are as follows:

Medicaid

As with Medicare, the number of services that are now covered under the expanded telehealth policy have significantly increased. While Medicaid coverage is different from state to state, as of March 2021, Medicaid fee-for-service offers reimbursement for:

  • Live video in 50 states and the District of Columbia
  • Remote patient monitoring in 23 states
  • Asynchronous healthcare in 16 states

Review the General Telemedicine page on Medicaid.gov for more information on which states provide what type of coverage.  

Private Insurance

Currently, twenty-six states have laws in place requiring that private insurance providers completely reimburse healthcare providers for any telemedicine services rendered. Additionally, another seventeen states have some measures in place to ensure at least partial payment or payment for certain covered services. 

While the laws differ from state to state, the majority state that insurance providers cannot take a patient’s location at the time of service into account when processing reimbursements. This means that whether the patient is at home, at work, or anywhere else, they will still be covered for the telehealth service – providing that coverage is in place for the service.

The majority of insurance providers now cover telehealth video visits, although some may require that a patient be established with an in-person visit before telehealth coverage can begin. Review this list of State Telehealth Laws and Reimbursement Policies to determine eligibility. 

It is also beneficial to keep in mind that coding for private insurance claims is different than coding for Medicare or Medicaid reimbursement claims. Here is a list of coding guidelines and scenarios for private insurances during the COVID-19 public health epidemic. 

Additionally, payment amounts vary between states and between insurance providers. While some states have laws that require telemedicine to be paid at the same rate as in-person visits, others leave the coverage amount up to the provider. If your state does not currently have a parity law, it can be beneficial to call the insurance provider as they may offer coverage anyway. 

Keeping Patients’ Health Information Safe

One of the primary concerns that most patients express when it comes to telemedicine is the safety and security of their personal information and their health information. All communications that occur during a telehealth visit are under the same HIPPA privacy laws as in-person appointments.

Although patients will be connecting to their telehealth appointments using their own internet connection, or in some cases a public Wi-Fi, their information will still be secure. Providers must use a secure patient portal to conduct the appointment which is encrypted per HIPPA privacy standards and guidelines. 

In the majority of cases, a patient will use their phone, tablet, or computer to log into a secure patient portal to interact with their physician during their telehealth visit. In some cases, however, doctors have been allowed to utilize existing video conferencing applications such as Skype, Zoom, and Google Meet to conduct these visits. 

Prior to utilizing this technology, providers should ensure that the vendors that they are using are willing and able to ensure additional privacy and security measures for these telehealth visits. It is recommended that a provider reach out to these vendors prior to using them to enter into a HIPPA business associate agreement to ensure privacy and security. 

Patients should be informed that they should find a quiet, unoccupied room where they can be sure of their privacy during the visit. Providers should also ensure that they are in a room with a door that can close and that they remain alone for the duration of the visit unless express consent is obtained from the patient. 

Other information that should be shared with patients to help them protect their information online includes:

  • Do not access a telehealth appointment with anyone not in your immediate family
  • Try not to use public Wi-Fi to access telehealth appointments – if it is necessary ensure that your provider offers additional safeguards through their patient portal
  • Do not use any Wi-Fi connection that is not password protected – if your personal Wi-Fi does not have a password, add one immediately
  • Ensure that you have an active and up-to-date anti-virus software installed and enabled on your device prior to your telehealth visit and prior to entering any information online
  • Do not provide any information over the phone, via email, or online to any person, number, or website that you do not recognize – when in doubt, disengage from the conversation and call a number that you know leads to your provider
  • Do not enter any private information on a website unless there is a lock icon in the address bar

Additionally, it is essential for healthcare providers to ensure that their computers and systems are protected by strong authentication measures, end-toend encryption, and up-to-date operating systems, applications, and anti-virus software. 

Finally, ensure that your team is trained in recognizing emails, applications, and software that contain fishing attempts or obvious viruses. Phishing is the number one way that sensitive information gets leaked. 

Malpractice And Liability

There are several legal considerations that providers should keep in mind when offering telehealth appointments. One of the most important security concerns to keep in mind is keeping patients’ health information protected. 

Patient health records are frequent targets of phishing efforts, hackers, and malware viruses. For this reason, having a strong knowledge of cybersecurity, or at least an IT department that is well-versed in cybersecurity, is essential. 

Here are a few helpful guides to review when considering what sort of cybersecurity measures your practice should implement:

It is important to note that although HIPPA requirements regarding using existing video conferencing applications for telehealth visits have become more lenient during the COVID-19 public health epidemic, this allowance is not intended to be permanent. 

When the pandemic has been declared over, all telehealth communications will need to adhere to the original HIPPA standards of communication. 

There are some final things to consider when deciding to offer telemedicine appointments. First, ensure that your existing liability insurance company covers telehealth. While some insurance providers may cover it, some providers may need to purchase supplemental liability insurance. 

For providers who wish to offer telemedicine across state lines, ensure that you will be covered by your liability insurance in each state that you are practicing medicine in. 

Check your local and state laws regarding the way that you are instructed to collect and store protected health information. 

Finally, some additional information on legal considerations:

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These terms and conditions are provided by The National Phlebotomy Provider Network (“NPPN”) and fully describe the terms under which the services are provided by NPPN.

1. NPPN provides an independent medical and research specimen collection, processing, and delivery service. NPPN IS NOT a medical laboratory and does not conduct laboratory testing. NPPN IS NOT a partner or subsidiary of any medical laboratory.

2. Once specimens are delivered, NPPN has no control over the handling, processing, and testing of specimens, or reposting of those results to the prescribing practitioner. The laboratory is solely responsible for proper handling, processing, testing, and results reporting. NPPN is NOT responsible IF the laboratory fails to do any of the above properly or in a timely fashion.

3. While most common laboratory tests require the same or similar type of sample (whole blood, plasma, serum, urine, etc.) no matter what laboratory is performing the testing, every laboratory has its own specimen requirements for sample type, processing, and handling. While every effort is made to collect adequate and acceptable specimens, it is impossible to know the specific requirements for every test done by every laboratory. Furthermore, some laboratory tests cannot be collected in the field because the sample requires special handling that is impossible to perform outside a laboratory environment. In addition, some laboratory tests require the sample to undergo additional processing IN THE LABORATORY, as soon as it is delivered to the laboratory, which cannot be done in the field. Given these facts, there is a possibility that inadequate samples or no samples will be obtained. NPPN is NOT responsible [f the laboratory fails to perform any additional pre-analytical sample processing required after we deliver the samples to the laboratory.

4. PLEASE DO NOT CONTACT NPPN ABOUT YOUR TEST RESULTS NPPN has no access to the test results. You should contact the practitioner who ordered the laboratory testing for you or the laboratory who is conducting the testing directly. However, you should be advised that most laboratories are prevented by law firms releasing results directly to patients.

5. NPPN specimen collection and delivery services are provided ONLY at the direction of and under specific order from a duly licensed medical practitioner authorized to prescribe and order medical diagnostic testing. You cannot request specimen collection services without a valid laboratory order from an authorized medical practitioner.

6. NPPN personnel cannot materially change or in any way alter the laboratory order provided by your prescribing practitioner. It is against the law for any medical care provider to change a practitioners order without express consent from the prescribing practitioner. Likewise, you cannot materially change or alter your prescribing practitioner’s laboratory order for you.

7. NPPN is NOT a medical practice and does NOT provide any medical diagnosis, prognosis, treatment, or any medical advice. We do NOT have any information relating to any treatment you are undergoing or any reasons for why samples are being collected. You should seek the advice of a licensed practitioner for any question about any symptom or condition you are experiencing. If you are experiencing a medical emergency you should call 911 immediately! Do not attempt to access emergency care through our service. If you are unsure of what type of care you need, please contact your personal physician. NPPN does not dispense or deliver medicine of any kind. NPPN cannot prescribe medication or evaluate the effectiveness of any medication you may be taking.

8. NPPN is not a limousine or personal courier service. We cannot transport you to any doctor’s office or hospital. We cannot deliver any personal item to any location on your behalf.

9. NPPN services will be provided IN the patient’s home, work, or other appropriate stationary location. An appropriate location is one where patient privacy and safety are provided. NPPN does NOT and will NOT provide services inside any vehicle. NPPN does NOT and will NOT provide services in any public location.

10. NPPN performs all services and functions in the ordinary course of business and during normal business hours. NPPN is a NON-EMERGENT service and should NOT be used for collection and delivery of STAT or UGENT laboratory orders. All services are scheduled in advance and therefore we cannot guarantee accommodation of requests for “same day” schedule changes. Expedited collection and/or delivery of any specimen is NOT possible unless scheduled in advance. Because travel is inherently unpredictable, we do not guarantee or warranty any specific delivery time.

11. Scheduling Policy: We recognize that your medical care is very important to you and we respect your desire for timely medical care. Generally, appointment scheduling is conducted on a first-come, first-serve basis. However, scheduling for some patients may be prioritized based on medical need. NPPN will attempt to contact you to schedule an appointment within 24-48 hours upon receipt of your request. We make every attempt to schedule your appointment at a time convenient for you but cannot guarantee any specific time or ongoing duration of availability.

12. We have a 48-hour cancellation policy. Appointments canceled without at least 48 hours’ notice will be charged a 50% cancellation fee for all services scheduled on that day. Appointments canceled at the time of service or “no shows” “vi ii be charged the full fee for services scheduled on that day.

13. EXCEPT AS EXPRESSLY STATED HEREIN THE SERVICES OF NPPN ARE PROVIDED ON AN

“AS IS, AS AVAILABLE” BASIS. NPPN AND ITS AFFILIATES, SUPPLIERS, AND PARTNERS MAKE NO WARRANTY, REPRESENTATION, GUARANTY OR CONDITION OF ANY KIND, WHETHER IMPLIED, STATUTORY OR OTHERWISE, INCLUDING, WITHOUT LIMITATION, WARRANTIES OF MERCHANT ABILITY OR FITNESS FOR A PARTICULAR PURPOSE.

14. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, NEITHER NPPN NOR ITS AFFILIATES, SUPPLIERS OR PARTNERS WILL BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, EXEMPLARY, PUNITIVE OR CONSEQUENTIAL DAMAGES IN CONNECTION WITH OR ARISING OUT OF THE SERVICES, EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. SOME STATES/JURISDICTIONS DO NOT ALLOW EXCLUSION OF IMPLIED WARRANTIES OR LIMITATION OF LIABILITY FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES, SO THE ABOVE LIMITATIONS OR EXCLUSIONS MAY NOT APPLY TO NPPN. IN SUCH STATES/JURISDICTIONS, NPPN’S LIABILITY AND THAT OF ITS AFFILIATES, SUPPLIERS, AND PARTNERS WILL BE LIMITED TO THE GREATEST EXTENT PERMITTED BY LAW.

15. These terms constitute the entire understanding between you and NPPN and no amendment or modification of its terms shall be valid or binding unless in writing and signed by an authorized representative of NPPN.

Last Updated: November 20, 2023

Terms of Use for National Phlebotomy Network Customer Portal

Introduction

Welcome to the National Phlebotomy Network Customer Portal, accessible at https://phlebotomynetwork.com. These Terms of Use ("Terms") govern your use of our website and services ("Services"), and by using our Services, you agree to be bound by these Terms.

Acceptance of Terms

By clicking "I Agree" during the sign-up process or by using the Services, you agree to comply with and be bound by these Terms. If you do not agree to these Terms, please do not use the Services.

Privacy Policy

Your privacy is important to us. Please read our Privacy Policy to understand how we collect, use, and protect your personal information.

User Account

Account Creation: To use the Services, you must create an account. You agree to provide accurate, current, and complete information during the registration process and to update such information to keep it accurate, current, and complete.

Account Security: You are responsible for maintaining the confidentiality of your account password and for all activities that occur under your account. You agree to immediately notify us of any unauthorized use of your account.

Use of Services

Permitted Use: You agree to use the Services only for purposes that are permitted by these Terms and any applicable laws and regulations.

Prohibited Use: You may not use the Services to engage in any illegal activities or to violate anyone's rights, including intellectual property rights.

Data Protection

Data Storage: We take reasonable measures to protect your personal information, but we cannot guarantee its absolute security.

Data Usage: We use Stripe for payment, analytics, and other business services. Stripe collects identifying information about the devices that connect to its services. Stripe uses this information to operate and improve the services it provides to us, including for fraud detection. You can learn more about Stripe and read its privacy policy at https://stripe.com/privacy.  

Intellectual Property

All content on the Services, including but not limited to text, images, and code, is owned by National Phlebotomy Network and is protected by copyright and other intellectual property laws.

Termination

We reserve the right to terminate or suspend your account and access to the Services at our sole discretion, without notice, for conduct that we believe violates these Terms or is harmful to us, other users of the Services, or third parties, or for any other reason.

Changes to Terms

We reserve the right to modify these Terms at any time. If we make changes to these Terms, we will notify you by updating the "Last Updated" date at the top of this document.

Governing Law

These Terms are governed by the laws of the State of California, without regard to its conflict of laws principles.

Contact Information

For any questions about these Terms, please contact us at (415) 851-2425.

Last Updated: November 22, 2023

Information Privacy Notice

This Information Privacy Policy has been adopted in order to maintain clear standards of privacy and security with the information we are provided by customers for confidentiality. It states:
(1) We will not sell or provide secure proprietary information input by customers to any outside parties except as expressly authorized or implied by specific request for services that requires the disclosure of your information in order to provide said services requested; and
(2) No customer information is kept on a publicly available server.

By accessing this web site, users agree to be bound by all of the terms and conditions of the guidelines set out in this Disclaimer. Do not consult this web site unless you agree not to hold NPPN liable for any errors or omissions.
We offer our services as prescribed by a duly authorized and licensed medical practitioner or other healthcare provider. The services or products found listed on our web site are intended for use by duly authorized and licensed medical practitioners or other healthcare providers in the delivery of appropriate medical care to assist practitioners diagnose and treat disease. We give no warranty that any of our services will prevent disease. All material is provided for educational purposes only and is not intended to be a substitute for a physician’s consultation. Although NPPN encourages increased self-awareness and self-care, all readers are strongly encouraged to consult and work with an experienced healthcare practitioner. Individuals with health disorders, medical conditions, or any condition needing medical supervision assume full responsibility for obtaining such professional medical assistance. Consult your physician regarding any symptoms or medical condition. We specifically disclaim any expressed or implied warranties or merchantability of fitness for any particular usage, application or purpose. NPPN does not recommend self-diagnosis or self-medication, and no information within this web site or presented by NPPN or its associates may be construed or interpreted as recommending self-diagnosis or self-medication.

If a laboratory test result is outside normal range, you should immediately see your prescribing physician. Many tests, to be validated, will need to be repeated at the discretion of a physician. Laboratory test results may vary depending upon age, sex, time of day blood sample is taken, diet, medications, and the limits of modern technology. A single laboratory test or group of tests cannot guarantee good health. False positive and false negative test results are possible. There are various medical diseases that cannot be uncovered by these tests alone. Testing by the medical laboratory staff to whom your medical specimen is delivered by us, only constitutes a partial evaluation of your state of health and does not represent a diagnosis or treatment of disease.

NPPN shall not be liable to you or anyone else for any loss or injury caused in whole or in part by procuring, compiling, interpreting, delivering or reporting information through this web site. In no event shall NPPN be liable to you or anyone else for any decisions made or action taken or not taken by you in reliance on such information. Material placed online by users does not represent medical advice of NPPN and we make no representations with respect to the accuracy, reliability, completeness, timeliness or usefulness of the contents.

Privacy Policy
The general position of The National Phlebotomy Provider Network on implementation and compliance with HIPAA and other privacy laws is as follows:

A. Protect and enhance consumer’s rights of access to information.
B. Improve healthcare quality by restoring trust in the system.
C. Improve efficiency of delivery with national framework.
D. NPPN will not use or disclose an individual’s protected health information (PHI) except as otherwise permitted and/or required by HIPAA.
E. PHI may be used only for treatment, payment, or healthcare operations. All other uses and disclosures will be by authorization only and Patient may revoke authorization.
F. All NPPN Patients will receive and acknowledge the Privacy Notice. It is also available for the asking by mail or email. It is also carried by each field service technician and available upon request.
G. Privacy Notice will describe how medical information about Patients may be used and disclosed and how they may access said information.
H. NPPN will make reasonable efforts to limit disclosure of PHI as much as possible.
I. Continuing compliance with HIPAA will be achieved through ongoing assessment, oversight and informational training, as coordinated through the privacy officer.
J. NPPN shall address all complaints received from patients, clients, employees or third parties in an expeditious and meaningful manner.
K. NPPN respects the rights of individuals, including employees, to make complaints, ask questions or inquire as to NPPN’s compliance with HIPAA and other privacy laws.
L. No adverse action or retaliation shall be taken against any such individual or employee based on any legitimate complaint, question, or inquiry.
M.NPPN must identify those members of its workforce that require access to protected health information to perform their duties, specify the protected health information to which they require access and make reasonable efforts to limit their access accordingly.
N. All employees will be trained in order that NPPN will be HIPAA compliant. New employees will be trained on a regular basis to ensure continued compliance with new personnel. Personnel will be retrained if significant changes occur which affect HIPAA or privacy laws. Employees, who fail to follow HIPAA requirements and/or the policies of NPPN with respect to privacy rules, shall be sanctioned appropriately. Such sanctions may range from verbal reprimand to termination. Any intentional breach of patient confidentiality, not permitted by law, shall be severely punished. All such sanctions shall be documented, in writing, by NPPN.
O. To the extent practicable, NPPN will mitigate the harmful effects of any known use or disclosure, by itself or its business associates that is in violation of the privacy rule and/or NPPN’s policies and procedures.

For more information on our information privacy practices, or to file an information privacy concern, please contact The National Phlebotomy Provider Network’s Information Privacy Officer at: The National Phlebotomy Provider Network, Inc. 8871 W. Flamingo Rd. Ste 202 Las Vegas, NV 89147.