The 7 Essential Elements for Telemedicine Implementation
PC groups, HIPAA compliance and launching your practice
So you’re starting a telemedicine practice, congrats! That’s a big, and exciting, move and we’re here to help support you in building a successful, and compliant, telehealth business.
There are a few things you should keep in mind when organizing your new virtual care practice. These include understanding the important role of PC groups, acquiring payer contracts, hiring your clinicians, scoping services and actually launching to patients. Don’t worry, in this blog we’ll break down the critical steps to each one of these in order to set you up for success. Let’s get started!
PC Groups and MSOs
What is a Professional Corporation (PC Group)?
This first thing you need to do is build out your PC groups. When setting up a Professional Corporation, or PC Group, it must be organized by at least one licensed individual, a physician in this case, for the purpose of providing professional medical services and obtaining tax advantages.
Each state has slightly different guidelines to review, but one helpful rule of thumb is the need for roughly one PC Group per state you serve patients in. If your goal is to offer services nationwide, building those PC groups is going to take some time to plan. However, it’s an extremely important part of keeping your practice legal and compliant.
Other things to consider:
$1000 per PC group
1-2 months to establish
Different names and identities per PC
Separate bank accounts and financial structures
Clearly defined decision-making roles between the two entities
The role of MSOs and the “Friendly PC” model
Another term you might hear in the virtual care world is “Friendly PC”. This is when a PC contracts a Management Service Organization (MSO) to provide managerial and administrative services—acting as an umbrella to your practice.
The PC has full control over the clinical aspects of the business like contracting clinicians and delivering care. The MSO is there to offload the non-clinician operations including billing, coding, collections, credentialing and employing non-healthcare professionals for business operations. This allows your PC groups to focus on delivering exceptional care and serving more patients.
Why are PC Groups Important?
In addition to what we mentioned above, PC groups are an essential part to building your telemedicine practice in order to practice virtual care legally. Being diligent about setting up your PC groups according to industry regulations can save you a lot of trouble and lawsuits down the road.
The next element you’ll want to consider is building your payer network. Payer contracts are held by the PC Group and are what actually allow you to bill your patients’ insurance providers. Each takes anywhere from six to nine months to secure and will cost you $500 per contract.
Unfortunately, this process takes some time, and there’s really no way around it when you’re just starting out your telemedicine business. You’ll need to acquire insurance for every state you offer services in. Once you’ve been in the industry longer and have acquired more experience under your belt, you may be able to renegotiate your rate.
Thanks to recent policies extending telehealth flexibilities for another two years, it’s made telemedicine services more affordable to clinicians and patients. Most private insurers are required to reimburse some type of telehealth service, but there is still no universal coverage, yet.
If you’d like a more detailed deep-dive into payer coverage and the enrollment process,check out our Guide to Payer Enrollment for Telehealth Companies. You’ll get access to process timelines and a full list of documents to have ready.
Now that you’ve set up your PC groups and payer contracts, you are ready to hire your clinicians! However, you still have some decisions to make.
Hiring and staffing the right clinicians for your organization and your patients is going to require a full-time recruitment effort from writing the job descriptions to posting them to vetting candidates thoroughly across multiple interviews. Then there’s still the work of establishing salary, scheduling, location (in-person or virtual) and license verification for each position you fill. If this sounds like too much of an internal lift, outsourcing might be a good route to explore.
Outsourcing involves tapping into a pre-vetted clinician network and contracting out the providers you need from there. The benefit of this model is you don’t have to front all of the resources required to build out, manage and nurture your own clinician network. Allowing you to start serving patients quicker, while offloading many of the personnel headaches. One con is that you are offloading part of your business so it can sometimes be difficult to find the right, trusted partner to ensure all the clinicians you’re working with are good fits.
Licensing and credentialing
Licensing and credentialing is another important element when establishing a practice and it plays a pivotal role in both your hiring, payer enrollment and telehealth delivery processes.
Ensuring all the clinicians you hire are properly licensed and credentialed is essential to staying compliant with federal and state laws and regulations. Additionally, each clinician must be licensed in each state they wish to practice in. For example, say you’re trying to target a group of 10 specified states as you start your telemedicine practice. You’ll need to license your providers in every single one of them, ideally with some providers holding multi-state licenses—this can take some time.
Each application costs about $1000 each and could take anywhere from 3-6 months to a year. Often, telehealth companies hire specialists to keep track of license applications and renewals. If this isn’t something you can internally support, there are telehealth support companies that provide clinician licensing and credentialing services.
Once you have your licenses, your clinicians now need to be credentialed with an in-network insurance provider.
HIPAA compliant software
The technology you use is an important part to generating an exceptional patient experience while adhering to the HIPAA requirements for video conferencing and PHI exchange.
A 2021 survey done by software company Redpoint Global showed 80% of people surveyed said they preferred to use digital communications with their providers at least some of the time. On the flip side, the surveyors noted that some industries, like retail and banks, provide better personalized experiences across channels than healthcare organizations.
Patients have begun to expect more from their healthcare experience, so it’s important to evaluate what digital platform is going to work best for your practice. Here are some questions you should ask when deciding on an EHR platform:
Does the digital health platform align with clinical goals?
Can it support both sync and async visit types?
Can the platform seamlessly integrate with your EHR?
Are there HIPAA functionalities built into the platform?
Does it easily integrate with secure telehealth tools?
What kind of patient journey does it offer?
Does the platform offer room to scale as you expand your services?
What kind of vendor technical support does your digital platform come with?
Video conferencing software
This type of synchronous telehealth delivery is typically covered by most private payers and medicare. However, in order to be approved for reimbursement from your insurance payer, the software must meet HIPAA requirements.
Creating and maintaining your own video software can be costly and often requires developers to set it up properly. There are outsourcing options from companies like BlueJeans Telehealth by Verizon and Zoom that will seamlessly integrate with your current telehealth platform.
Scope of services
Okay, so now you have your PC group set up, payer contracts negotiated, a clinician network with the right licensure and credentials and a secure platform to deliver care on. The next step is deciding what services you want to support and offer your patients. Do you want to focus on primary and urgent care, sexual health, mental and behavioral health or all of the above?
Chances are, you’ve already had these top of mind when hiring the right clinicians, but now is the time to do a final resource audit on what you can actually support. There is always room to scale down the road.
Iron out your launch plan
Before launching your telemedicine practice, there are a few last things you need to iron out. For a more complete checklist to help make your launch as seamless as possible, our whitepaper “How to Launch and Scale Your Telehealth Company” is an excellent in depth resource.
Your high-level launch checklist should include:
Establish brand, messaging, website and social media presence
Set goals, hire experts and map out patient acquisition strategy
What does your process look like?
Are you staffed to support the anticipated volume?
Map out your ideal patient journey from beginning to end
How are you going to handle ongoing touchpoints?
Leading the industry in telehealth delivery
As you begin building your telemedicine practice, we’d like to introduce OpenLoop! We offer a full-suite of superior services that give health organizations and their providers scalable tools to build better patient outcomes. Services like our intuitive, API driven technology platform and 6000+ NCQA accredited clinician network—just to name a few—allow our clients to manage their patients and build a successful telehealth company.
Interested in what our services can offer your organization? Get in touch here!
Our full suite of Telehealth Support Services include:
You might also like...
Tap into our nationwide network of certified expert clinicians and a team dedicated to delivering quality of care seamlessly to your patients.
Is Your EHR and Health Platform Working for You?
Patients expect more from their healthcare experience. Is your EHR and digital health platform meeting those demands, or falling short?