Issues to Be Aware of Before Utilizing This Increasingly Popular Tool

By Melanie Balestra, NP, Esq.

I get many questions about starting telehealth in a practice. The fastest growing specialty in this area from my experience is psychiatry. Psychiatry does not require a physical examination of a patient so is not an invasive communication. However, other specialty areas can still incorporate telehealth in follow up exams of patients, especially if the patient is in another state or assessment tools are incorporated in the patient’s location.

Issues to be aware of include:

• The NP must be licensed in every state that they provide patient services.
• The NP must have a DEA license in every state that they plan to prescribe scheduled drugs.
• Some states require the NP to have the first visit be an in-patient visit.
• Some states require the NP to have the first visit and a follow up visit in the office when prescribing a scheduled drug.
• Telehealth reimbursement policies vary from state to state and insurance to insurance.
• Telehealth must follow HIPPA and HITECH rules. FaceTime cannot be used.
• The NP does not need a collaborating physician in states that do not require them, but must have a collaborating physician in the states where this is required.
• Do not do telehealth out of your home. Have a professional office.
• Seek appropriate patient consent.
• Educate the patient on the telehealth format.
• Provide information about the encounter, prescribing policies, communication and follow-up, potential risks, mandatory reporting, credentials of the distant site NP and billing arrangements.
• Seek legal advice if you plan to start a telehealth practice.

For more information read “Telehealth and Legal Implications for Nurse Practitioners,” The Journal for Nurse Practitioners, Volume 14, Issue 1, pages 33-39. You can also learn more by reading “Get Ready for Telehealth,” an article which appeared in the August, 2019 edition of Connections.

Melanie Balestra is both an attorney and a nurse practitioner. She is a former President of CANP, and is currently President of the American Association of Nurse Attorneys, which in 2016 honored her with the award for Outstanding Health Law & Compliance Section Member. She has law offices in Irvine and Newport Beach, and continues to work part time as a PNP and Director of Pediatrics at the Laguna Beach Community Clinic.