Teledermatology after COVID-19

By Swapna Pachauri, MPH, Manager, Health Technology & Informatics, April 1, 2022

Each month, DermWorld tackles issues “in practice” for dermatologists. This month, practice management staff offer tips on clinical photography in dermatology.

Since the public health emergency (PHE) began two years ago, telemedicine has revolutionized and opened doors to a new digital world of medicine, especially for dermatology. Prior to the PHE, there were legal barriers for practicing within and across states lines, as well as limited technology options. Now, more practices and institutions are adopting telemedicine with better technology capabilities, and several states have relaxed their licensing rules for physicians to practice. Private payers and federal policymakers are also beginning to embrace virtual care, and expanding coverage as telemedicine becomes an essential form of care delivery.

Is your staff prepared to integrate teledermatology into your practice? What does telemedicine after the pandemic look like? Below are tips and best practices to help ensure your practice’s adoption and/or expansion of teledermatology services are able to provide the best patient care and meet your individual practice goals.

Types of virtual encounters

There are several teledermatology encounter options available outlined in detail in the Academy’s Teledermatology Toolkit. These include live-interactive, store-and-forward, and audio-only options and can be easily adopted into a practice or expanded upon depending on your practice’s needs.

Live-interactive (synchronous) – Takes advantage of videoconferencing as its core technology. The dermatologist and patient are separated by physical space, but interact in real time.

Store-and-forward (asynchronous) – Provides asynchronous consultations to referring physicians or directly to patients. A dermatologic history and a set of images are collected at the originating site and transmitted electronically for review by the dermatologist. In turn, the dermatologist provides guidance to the referring provider or to the patient.

Audio-only – Refers to a method of providing real-time teledermatology services without the use of photographs or video.

Read more about in-depth technical specifications in the Academy’s position statement.

Each type of virtual encounter has its own advantages and disadvantages. Some of the advantages include increased and expanded access to dermatologic care, specifically in remote or underserved areas; minimized delays in care due to barriers in distance or availability of in-person appointments; increased patient satisfaction; and expanded access to patient health records from anywhere. Some possible disadvantages are that some patient visits are not suited for teledermatology and technology is not always fully reliable.

To ensure you select which method(s) are right for your individual practice, we recommend that you and your staff review all the options, outline the pros and cons for each, create an implementation plan, and learn how to document each visit correctly for proper reimbursement.

Preparing and integrating your practice

Whether your practice has been offering telemedicine for years or is new to adopting it, ensure you define and assign staff roles appropriately. Assign roles by matching responsibilities to appropriate skillsets and offer additional training resources to successfully achieve full optimization of integrating telemedicine into the practice. You can delegate one person, a team, or even cross-train current staff, including any non-physician clinician (NPC). Determine who will schedule appointments, initiate virtual visits with the dermatologist, and bill patients. This will ensure that telemedicine is adopted efficiently into your practice.

When choosing a teledermatology vendor for your practice, have staff check with your current EHR to see if they provide different telemedicine options through mobile apps. Some may even have cost-effective add-on options for dermatologists to review conditions, provide treatment plans, and even collect and store photos more inclusively in a secure manner. These add-ons could offer more streamlined processes and minimize administrative documentation burdens for your staff and patients including communication, scheduling and/or confirming appointments, timely and accurate billing, and documenting processes — a bundle package all in one place. Learn more about choosing the right telehealth vendor for your practice.

Once you have selected the right vendor, consider if you have a teledermatology-specific workflow in your practice. The Academy created a sample workflow to improve the integration process of teledermatology for your staff and patients. This workflow is designed for small or solo practices and highlights operations regarding technology setup, scheduling visits, check-in process, appointment setup, and follow-up visits. Customize the workflow to fit your practice!

Lastly, don’t forget, telemedicine apps and vendors are generally considered Business Associates (BAs), therefore you should have a signed BA agreement on record. Also, check with your state and malpractice provider to ensure the services you provide are covered. As mentioned, many states have relaxed regulations during the pandemic. View updates on the Federation of State Medical Boards website.

Reimbursement guidance

Are telemedicine visits reimbursed the same as in-person visits? Medicare does reimburse synchronous teledermatology encounters reported with CPT code 99202-99215 at the same rate as in-person encounters, provided they are reported with place of service (POS) 11 and modifier 95 to indicate the encounter was performed via telecommunication technology. Currently, Medicare also allows reporting of telehealth services rendered via telephone to Medicare beneficiaries for the duration of the PHE, and telephone CPT codes 99441-99443 are reimbursed at the same rate as established patient E/M codes 99212-99214.

As reporting requirements continue to evolve during this time, the Academy recommends contacting all private payers you accept to ensure you are meeting their individual telehealth coverage policies.

What’s next?

It is significant to note that where telemedicine stands today is not the same as it was prior to the pandemic. As teledermatology continues to be adopted into practices, the Academy will focus on improving patient access to care and expanding the scope of telemedicine. Specifically, the Academy will work on teledermatology-specific policies within federal legislation to make COVID-19 telehealth waivers in Medicare permanent.

The Academy’s Teledermatology Task Force developed a set of standards that were derived from the Academy’s teledermatology position statement and recently approved and published. This year, these standards will be shared with external stakeholders, including policymakers, private payers, and EHR vendors, to promote increased access to dermatologic care to align our standards with their policies in the future. These standards will serve as a foundation from which our member advocates and professional staff will advocate to Congress.

It is no surprise that dermatology, like other specialties, has faced several challenges brought about by the PHE. While not perfect and with some limitations, the adoption and expansion of teledermatology offers many opportunities for dermatologists to continue to offer the optimal care that their patients are accustomed to.

To learn more about integrating telemedicine into your practice, visit the Academy’s Teledermatology Toolkit.

Additional DermWorld Resources