Legal Update: Health Care Law

Advising the Modern Day Columbus: A Checklist for the Multi-State Teleradiology Provider

by Mark A. Cunningham & Douglas S. Griswold

As reimbursement rates for imaging services have steadily decreased in recent years, many radiologists have chosen to pursue new opportunities in far away places to boost their revenue streams.  Like modern day explorers, these brave new radiologists for hire gather up their essentials (usually consisting of remote reading equipment, cutting edge software systems, and an advanced degree or two) and wander into new states hoping to find a willing hospital or facility that could use their help. While these adventurers tend to be well-experienced in their home states, they often find themselves dazed and confused by the laws and regulations of the new states in which they find themselves.

We’ve been lucky enough to assist some of these travelers in their past journeys.  While each state will have its own set of unique challenges, we believe that almost each new multi-state endeavor will end up confronting the same basic set of issues.  We have tried to put together a checklist that a radiologist can consult before he embarks on an adventure with a hospital in a far away land.

• Licensure - It is a standard requirement that every physician be licensed in each state where he or she provides medical services.  Teleradiologists generally are not exempt from this requirement.  Physicians should confirm with the applicable licensing board in every state where they will be performing teleradiology services whether they will need to obtain a state medical license before providing such services.
• Hospital Credentialing/Privilege - Most hospitals require that physicians performing medical services on their premises maintain privileges at the facility.  Generally speaking, this requirement to maintain privileges will extend to physicians performing telemedicine services on behalf of the facility.  As such, radiologists should check with each facility regarding its credentialing policies to make sure that they meet all staff requirements before initiating teleradiology services on its behalf.
• Malpractice - Not every malpractice policy covers teleradiology services.  In addition, some policies will not cover medical services performed out-of-state.  Thus, before radiologists begin performing teleradiology services, they should confirm whether their current malpractice provider will cover such services or if they will need to obtain separate coverage in the new state where they will be providing services.
• Legal Qualification/Corporate Taxes - Assuming most radiologists practice medicine through a corporation or limited liability company, most states will require that such entity obtain qualification to do business in that state before providing teleradiology services within the state.  Related to this qualification requirement, there are often additional corporate reporting and tax filing requirements for which the entity will need to comply.
• Reimbursement - Radiologists may need to become enrolled with relevant payors in the new state where they will be practicing.  Given the significant timeframes often required to obtain payor enrollment, this is an area that the radiologists should focus on as soon as they make the decision to perform teleradiology services in a new jurisdiction so as to avoid any significant delays in payor reimbursement.
• HIPAA/Privacy Laws - In performing teleradiology services offsite, patient data will be transmitted electronically.  As a result, this data will likely constitute protected health information (PHI) triggering the protections of HIPAA or comparable state privacy laws. To ensure that such PHI remains protected, radiologists should ensure that any electronic communications are HIPAA compliant.
• Contractual Limitations - Many radiologists anticipate that they will use their existing equipment and/or space to perform remote teleradiology services.  If this equipment or space is located in hospital space, the hospital may not permit the radiologists to do this.  Radiologists should analyze their existing professional services agreements to ensure that they will not be violating the terms of such agreements by performing teleradiology services at the hospital on behalf of a different or new location.  In addition, relevant fraud and abuse laws should be consulted if the radiologist ends up using a hospital’s premises or equipment for work on behalf of another facility but doesn’t pay anything for that usage.

There are a number of important issues for radiologists to consider before heading out into the brave new world of teleradiology services.  With that said, the adventure can be rewarding if a radiologist is prepared.  With careful planning and consultation with experienced advisors, radiologists can avoid these legal pitfalls and enjoy the journey.