Private Medical Practice

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The coronavirus pandemic upended the health system in the United States as we know it, but many healthcare providers have worked to pivot and provide telehealth care within their private practice. Like many small businesses, health care providers’ business plans were interrupted when office shutdowns occurred across the country and staff members were sent home. With electronic health records and HIPAA-compliant technology tools, medical professionals are able to meet with patients, prescribe medication, and provide general care during the pandemic and stay at home orders.

We have compiled things to keep in mind while running a private practice from home – primarily focusing on medical care and logistics regarding medical billing. Of course, many things vary depending on the practice and on the patients that healthcare providers see. These tips are applicable to anyone in private practice, from therapists to general practitioners to specialists, and work to ensure that your small business practice can continue running smoothly during this time.

Technology in Your Private Medical Practice

The first big step for setting up your new practice from home is ensuring that you have the technological capabilities. Depending on how big your practice is, you may be setting up just for you or for an entire office. Most patients will opt to use real-time, audio-video communication via video conferencing software for telehealth, so we will be focusing on that technology. The main things to consider when selecting a vendor, according to the American Medical Association, are:

  1. Business
    • The financial stability, affiliations, and business model associated with the vendor.
    • Their expertise in telehealth and your practice’s medical specialty.
  2. Information Technology
    • Ability to integrate with your current system, including patient records and contact information.
    • Accessibility and ease of use for the patient and medical professionals, as well as office staff.
  3. Security
    • Supports compliance with HIPAA rules and local regulations with in-platform consent capabilities.
    • User authorization with liability structure for security breaches.
  4. Usability
    • Easy to use platform for patients and medical practitioners.
    • Engagement metrics with a dashboard that allows patients and practitioners to see important information.
  5. Customer Service
    • Technical support available during and after implementation of the program.
  6. Clinical Validation
    • Documentation that shows previous outcomes of using the vendor for telehealth.

Implementing the technology for all medical practitioners within your small business is important before scheduling an appointment with potential patients. Make sure that the service is secure and compliant with any necessary medical board or HIPAA requirements, and most importantly that your patients feel safe and secure meeting with a doctor via telehealth.

A number of services are available that have a variety of models that include HIPAA-compliance. Some popular services used for telehealth across a variety of medical specialties include: VSee, Zoom, eVisit, and Chiron Health.

Practice Management and Providing Care

As a small business owner running a medical practice with doctors who have experience and went to medical school, a lot of patient care will fall to the practitioners in your business. It is important for you to keep organized and abreast of the daily operations – like appointments, billing, and other administrative tasks – to ensure that doctors are focused on care and patients can focus on getting better.

The American Medical Association has many resources to aid with the implementation of telemedicine and remote care into your medical practice.

A lot of the regular procedures you would follow in your physical medical practice should be transitioned to the remote care service including forms before the appointment and specialist care. Health information from the patient is just as important during a virtual appointment as it is during an in-person consult. The goal of the visit is to provide the same level of care that the patient is used to receiving from your business.

It is important to remember that this process is new to you and to the patient, so there may be a learning curve and some hiccups along the way. As the business manager, you want to be there to provide options and help along the way. Yale Medicine, the clinical practice of the Yale School of Medicine, noted that “there were 34 video visits scheduled on one particular day in the pre-COVID-19 era, whereas [at the end of March], more than 1,500 video visits were scheduled [in a single day].”

Billing Options for Telemedicine in the United States

Since 2016, more private insurers have been including (and paying for) telehealth services, with seniors on Medicare becoming a growing population who use the service. Billing is an important part of all small businesses, and with medical practices it is no different. There are three different options depending on the insurance that your patient has when they have a telemedicine appointment with a medical practitioner.

Video visits are covered by most insurance companies, including Medicare and Medicaid.

  • States do have the option to determine whether or not to cover telemedicine, and, as of spring 2020, all 50 states by law provide Medicaid reimbursement for live video telehealth appointments. However, it is important to note that “the federal Medicaid statute does not recognize telemedicine as a distinct service.”
  • Due to the COVID-19 pandemic, medical professionals are allowed to use telehealth to treat patients who have Medicare. If a patient has coverage through a Medicare Advantage Plan, there are no out of pocket costs.
  • There are variables for people covered by Medicare, which includes how much you (as the practice owner) charge, whether your practice accepts the telehealth assignment, and the services offered. A lot of these variables will be discussed with the patient and determined through billing services.

Some important things to remember and consider as a business owner offering telemedicine for patients with private insurance:

  • According to eVisit, a telemedicine company, the Big Five – Aetna, Cigna, Blue Cross Blue Shield, Humana, and United Healthcare – all offer some form of coverage for telemedicine, but it is policy dependent.
  • There are currently 41 states plus the District of Columbia with laws that mandate coverage of telemedicine by private insurance.
  • However, there are only 5 states with payment parity laws (for private insurance) that mandate private payer reimbursement for telehealth appointments.
  • Even if a private payer is not required to cover telemedicine by law, many do anyways! It is important to check with insurance before taking on new patients and billing.
  • States will determine which medical professionals can practice telemedicine, as determined by the state medical board.
  • The amount providers are reimbursed will vary state by state; some states require that insurance companies reimburse the same for telemedicine as they would for an in-person visit.
  • For medical billing, it is easier to call the insurance company’s eligibility and benefits departments for codes and documentation. Many private payers are following the lead of Medicare for coding though.

For more information, the Center for Connected Health Policy (CCHP), a “nonprofit, nonpartisan organization working to maximize telehealth’s ability to improve health outcomes, care delivery, and cost-effectiveness,” has a map on their website where you can find the laws for your state on the telemedicine policy.

Helping Your Business Thrive

As a small business owner and medical practice owner during the COVID-19 pandemic, you are in the unique position of owning an establishment that can be acquiring new business. Unfortunately, as it is a medical pandemic, doctors and medicine are in high demand. You can use your emphasis on patient care through telehealth and virtual care appointments to attract potential patients. Prioritizing safety is of the utmost importance to many people right now, and being in a hospital or doctor’s office can easily spread germs.

Instead, focus your marketing strategy on the benefits of telemedicine and the knowledge of your healthcare providers. Social media and Google ads can ensure that your practice shows up – but follow all confidentiality and HIPAA compliance with posts! As many people have been experiencing a switch to remote work, knowing that their medical professionals have done the same can ease a worried mind. This is your time to gain new patients because of your accessibility and quality of care.

With a new business model for your practice, you also want to be sure that your office manager has transitioned to the remote interface and is able to help you, healthcare providers, and patients with any of their needs during virtual care or billing. A lot of the moving parts that you will be dealing with as a medical practice owner can be eased with a knowledgable manager who complements your understanding of booking and technology. The skills of your office staff, beyond the healthcare providers, will be integral during this pivot and will ensure that patients experience a seamless transition as you focus on their care and wellbeing.

Final Thoughts

The use of telemedicine and remote care by medical professionals during the COVID-19 pandemic is integral to ensuring the care of millions of Americans. The tips above are meant to help transition your own medical practice to perform remote care, but it is also important to ensure patients feel safe with the various medical services you provide. Always discuss medical care options with your patients and team members before implementing fully in your own business.

As medical practice owners, be it private practice or a clinic, it is important to know and understand the logistics of operating your practice during the pandemic. We hope that these tips will help your small business run smoothly as you transition to telemedicine.

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