Figure 2: Telehealth Compliance Checklist
£ Are the telehealth professionals licensed in
the state where patient located?
£ Are there practice standards for patient
examinations and remote prescribing?
£ Are professionals documenting and maintaining patient records of the encounters?
£ Does insurance policy cover
£ Is insurance carrier licensed in every
state where services are provided
£ Do services qualify as covered
£ Are services being coded to properly reflect
the place of service?
£ Is the telehealth service provider
Commercial Insurance, Medicare Advantage,
and Medicaid Managed Care
£ Does the state require commercial coverage
of services provided via telehealth?
£ Does the provider’s contracts reflect
said coverage and include negotiated
£ Has reimbursement other than FFS been
evaluated, such as PMPM, capitation
add-ons, or hybrid risk-bearing?
£ Does the informed consent form account for
services provided via telehealth?
£ Does is recognize patient freedom of choice?
Fraud & Abuse
£ If Medicare/Medicaid, does the arrangement
comply with the federal Anti-Kickback Statute?
(Check provider/vendor arrangements and
patient incentive programs)
£ If Medicare/Medicaid, does the arrangement comply with the federal Civil Monetary
Penalties Law? (Check provider/vendor
arrangements and patient incentive programs)
£ Does the arrangement comply with the Stark
Law? (Check all physician benefits, including
software and equipment tech, to ensure they
meet a Stark exception)
£ Does the arrangement comply with state
patient brokering laws and anti-kickback statutes? (Check provider/vendor arrangements
and patient incentive programs)
£ Does the arrangement comply with state corporate practice of medicine rules? (Check
not just where the brick & mortar facility is
located, but where the patients are located)
£ If capitated or PMPM compensation, does
the arrangement comply with state insurance
laws? (Check if exempt and, if not, conduct
£ Is there a credentialing by proxy agreement in
place that meets all the elements?
£ Does the hospital relying on proxy credentialing have such provisions in its bylaws?
£ Are the hospitals engaging in periodic
re-credentialing assessments and reporting?
Privacy & Security
£ Are there privacy and security protocols for
the telehealth offerings?
SAMPLE CHECKLIST ONLY – FOR EDUCATIONAL PURPOSES/DOES NOT CONSTITUTE LEGAL ADVICE
telemedicine services provide a benefit to facilities that lack the required bench of specialists.
These arrangements offer access to specialists
who can help deliver appropriate and quality
care, and this can potentially lead to a decrease
in the transfer of patients to other facilities.
The immediacy and rapid responsiveness
of these arrangements offer real benefits to
patients in need. One example is telestroke ser-
vice arrangements with rural hospitals.
In terms of structuring FMV payments for
these types of arrangements, there are several
things to consider. The key is to identify and
outline exactly what the entity is contracting with the physician or other organization
to provide. One approach is to structure the