Technology has removed geographic barriers for radiologists but numerous regulatory boundaries still exist for remote reads, with financial, operational and compliance implications.
JURISDICTION
What is the correct jurisdiction for the radiologist who is reading remotely? And is it different from the site of service billed under the technical component?
The jurisdiction for the radiologist is determined by his/her physical location when reading cases and Medicare requires billing to the correct jurisdiction. In other words, it is determined by the “seat” of the radiologist and not the location of the entity generating the study.
What about cases read via teleradiology?
The “seat” still prevails so billing goes to the jurisdiction where the radiologist is sitting at the time of the interpretation, even as the facility bills to the jurisdiction where it is physically located.
What if our teleradiology service uses offshore physicians?
The Medicare Benefit Policy Manual (Chapter 60-Services Not Provided Within United States), states, “Payment may not be made for a medical service (or a portion of it) that was subcontracted to another provider or supplier located outside the United States. For example, if a radiologist who practices in India analyzes imaging tests that were performed on a beneficiary in the United States, Medicare would not pay the radiologist or the U.S. facility that performed the imaging test for any of the services that were performed by the radiologist in India.”
What if the radiologist is working from a hotel or resort while on vacation?
CMS addressed this issue in a specific guidance for providing professional services at an “unusual and infrequent location,” noting in this instance the radiologist would “bill based on the location where the interpreting physician most commonly practices.”
LICENSURE
If the radiologist is licensed where professional interpretations are performed, is that sufficient for remote coverage?
State regulations can vary widely so it’s best to obtain a legal opinion before commencing a remote reading agreement; however, the American College of Radiology recommends licensing in both the state where the technical component is performed as well as in the state where the radiologist performs the interpretation.
Who determines licensure requirements?
Each state defines its own licensure requirements and the definitions are inconsistent, including in some instances, issuance of special teleradiology/telemedicine licenses. Practices will need to become familiar with state practice of medicine definitions and licensing parameters. For example, many states define the practice of medicine as occurring at the location of the patient and would therefore require licensing related to that site.
How much time does it take to obtain licenses in a new state?
The answer too often is, “longer than you think it will.” Once the application for a new license is submitted, the state verifies critical information for each physician, including a check of the status of other state licenses he may hold and any past disciplinary actions. This means the physician with an extensive array of state licenses will most likely take longer to progress through the review/approval process. The Interstate Medical Licensure Compact (IMLC) was developed to make it easier to obtain licenses to practice in multiple states and potentially reduces the amount of time involved.
MEDICAL MALPRACTICE COVERAGE
What is the best way to handle medical malpractice liability?
Part of the due diligence required for providing remote reading involves contacting the group’s medical malpractice carrier to identify current coverage and limitations. Standard policies may cover only one state, with endorsements required for multi-state activity or teleradiology.
ONGOING PROCESS CONSIDERATIONS
Setting up remote reading services involves a complex list of tasks, but maintaining these processes also demands ongoing diligence to ensure physician lists, staffing changes and licenses are updated and documented; coverage schedules, changes and sites of service verified and files including continuing medical education, expirations and renewals tracked.
ADMINISTRATIVE FOLLOW-UP
Accurate and complete billing relies on accurate and timely communications. As changes occur, please make sure MSN is kept up to date—both to ensure physicians are paid for the work they do and to prevent compliance problems.
Claudia Murray
RCC, RCCIR, FRBMA
Senior Vice President, Regulatory Affairs and Corporate Compliance Officer
Claudia brings an extensive background in Medicare regulations, law and billing processes having spent more than 20 years with the Medicare program in various roles. Prior to joining MSN Healthcare Solutions as their full-time compliance officer, Claudia headed a small consulting firm specializing in radiology and other hospital-based specialties. She consulted with MSN for 15 years in designing, implementing and advising on their compliance programs. Currently at MSN, Claudia is responsible for the myriad activities for HIPAA and corporate compliance as well as the Quality Payment Programs, bringing her full circle to CMS regulations and programs.
