Policyholder Services

I have been asked to do telemedicine screenings for diabetic retinopathy. Will my OMIC policy cover me for these activities?

With the exception of remote ROP screening, OMIC covers ophthalmic telemedicine services that are rendered within the scope of the insured’s training, experience, coverage classification, and licensure. OMIC is aware that telemedicine is widely used to screen for diabetic retinopathy. The American Academy of Ophthalmology’s 2004 Ophthalmic Technology Assessment, “Single-Field Fundus Photography for Diabetic Retinopathy Screening,” concluded that “single-field fundus photography with interpretation by trained readers can serve as a screening tool to identify patients with diabetic retinopathy for referral for ophthalmic evaluation and management.” The Assessment also cautions, however, that it “is not a substitute for a comprehensive ophthalmic examination.”

If your telemedicine activities cross state lines, please contact the medical board in the state(s) where your practice is physically located, as well as each state in which patients present for diagnosis, imaging, or other services, to confirm that you are in compliance with all pertinent laws and regulations. Some states require the physician to obtain full and unrestricted licensure in the state the patient presents. Other states issue special licenses to out-of-state practitioners for practicing telemedicine in their state. Still others may permit certain intra-specialty consultations from an out-of-state specialist without requiring in-state licensure, but require in-state licensure if a diagnosis is issued. It is the physician’s responsibility to ensure that he or she is licensed appropriately at both the transmitting and receiving sites. OMIC’s policy excludes coverage for any claim arising out of professional services incidents involving direct patient treatment by a health care provider that the provider does not hold the required license to provide.

If your out-of-state telemedicine services represent more than 20% of your practice, please contact your underwriting representative as special rating may apply.

For more information regarding the coverage of and risk management advice regarding diagnostic/interpretive services, please read the feature article, “Hidden Costs of Non-Traditional Revenue Sources,” and the Policy Issues article, “Coverage for Non-Traditional Services” in the Spring 2008 issue of the OMIC Digest.

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