Please see the BCBSND HealthCare News article from March 20, 2020 for temporary changes to telehealth that is effective from March 16, 2020 for the duration of the COVID-19 emergency period.
Telehealth is the use of interactive audio, video or other telecommunications technology that is used by a health care provider or health care facility at a distant site to deliver health services at an originating site; and that is delivered over a secure connection that complies with the requirements of state and federal laws.
Telehealth enables providers to extend their reach and improve their efficiency and effectiveness while still maintaining high quality care and attention to patient safety. The benefits and limitations of care delivery via telehealth is the responsibility of the provider. A provider using telehealth technologies in the provision of services to a patient must provide care of the patient consistent with traditional standards of care for the patient presentation. An examination or evaluation may be performed entirely through telehealth if the examination or evaluation is equivalent to an in-person examination. An examination that utilizes appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation would meet this standard, as would an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of their profession, providing necessary physical findings to the licensee.
Telehome monitoring, a form of asynchronous telehealth, which includes the use of electronic remote devices for remote medical intervention and assessment from a patient's place of residence, is out of scope for this policy. Please see BCBSND Corporate Medical Policy for Telehome Monitoring.
BCBSND allows industry standard ancillary asynchronous teleradiology.
The practice of health care is deemed to occur in the state where the patient is located. Practitioners providing health care to patients located in another state are subject to the licensing and disciplinary laws of the state of the patient's location and must possess an active license for their profession in the state of the patient's location.
Providers should meet or exceed applicable federal and state legal requirements of medical/health information privacy, including compliance with the Health Insurance Portability and Accountability Act (HIPAA) and originating site's state privacy, confidentiality, security, and medical retention rules. Providers are referred to €œStandards for Privacy of Individually Identifiable Health Information, issued by the Department of Health and Human Services (HHS). Guidance documents are available on the HHS Office for Civil Rights Web site at: www.hhs.gov/ocr/hipaa. An attestation by the provider signifying HIPAA compliance must be available upon request.
The health care provider should review and follow the technical and administrative guidelines published by the American Telemedicine Association for fundamental requirements when providing medical and other healthcare services using telecommunications technologies. When guidelines, position statements, or standards from any professional organization or society exist, health care providers should also incorporate those into practice.
The following services, including but not limited to, would not be covered under telehealth:
Synchronous telehealth-Synchronous telehealth means care delivery that occurs in real time between a patient at an originating site and a health care provider at a distant site, connected by video technology. It may include the use of peripherals, meaning medical cameras and equipment to allow specialized examination.
Asynchronous telehealth (also called store-and-forward) Electronic medical information, imaging, or communication that is transferred, recorded, or otherwise stored to be reviewed at a distant site at a later time by a health care provider or health care facility without the patient present in real time.
Types of asynchronous telehealth include:
Direct Supervision- Direct supervision means the supervising provider must be present in the office suite and immediately available to provide assistance or direction to the professional in training.
Distant site A site at which a health care provider or health care facility is located while providing medical services by means of telehealth.
Originating site – A site at which a patient is located at the time health services are provided to the patient by means of telehealth.
Provider of record (or attending provider) – the principal provider who oversees a patient's care. The provider of record provides primary and routine care, or oversees hospital care, and coordinates other specialized care for a patient.
Consultation An evaluation of a patient and resulting opinion or recommendation from a physician or licensed independent practitioner. Consultation evaluation is performed upon the request of a treating provider of record because the consultant has expertise in a specific clinical area beyond the requesting provider's knowledge. If, after completion of a consultation, the consultant assumes responsibility for management of a patient's condition, subsequent care codes should be used and not follow-up consultation codes.
Online visit A member initiated low complexity interactive patient encounter performed through a consumer device via telehealth platforms such as mobile health apps, kiosks, or web-based video available through an electronic health record (EHR) portal.
Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.
For information related to billing and coding, refer to Reimbursement Policy.
American Speech-Language and Hearing Association. Telepractices and ASHA: Report of the Telepractices Team. December 2001.
Krizner K. Telemedicine still looks for inroads to total acceptability. Managed Healthcare Executive. May 2002. 44-45.
Telemedicine for the Medicare Population. Summary, Evidence Report/Technology Assessment: Number 24. AHRQ Publication Number 01-E011, February 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcsums/telemedsum.htm (Last accessed 12/19/2002)
BlueCross BlueShield Association. Telemedicine Issue Brief. 1/30/1998.
Bashshur RL, Shannon GW, Bashshur N, Yellowlees PM. The empirical evidence for telemedicine interventions in mental disorders. Telemed J E Health. 2015 Dec 1. [Epub ahead of print]
Medicare Learning Network. Telehealth Services. Department of Health and Human Services. ICN 901705 December 2015
North Dakota Century Code 26.1-36-09.15
Federation of State Medical Boards. Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine April 2014 www.fsmb.org
American Telemedicine Association http://www.americantelemed.org/home
Center for Rural Health https://ruralhealth.und.edu/
Patient Protection and Affordable Care Act (ACA) Section 5002 https://www.hhs.gov/sites/default/files/ppacacon.pdf
CMS Manual System, Medicare Claims Processing Pub 100-04
Totten AM, Womack DM, Eden KB, McDonagh MS, Griffin JC, Grusing S, Hersh WR. Telehealth: Mapping the Evidence for Patient Outcomes From Systematic Reviews. Technical Brief No. 26. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I.) AHRQ Publication No.16- EHC034-EF. Rockville, MD: Agency for Healthcare Research and Quality; June 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm.