Thinking of Practicing Telemedicine From Abroad? 10 Questions to Ask A Telemedicine Company

Have an upcoming interview with a telemedicine company? Here are 10 questions to ask a telemedicine company to be fully informed about your potential new job and the possibility of practicing telemedicine from abroad.

1. In which setting are your providing care, and through which modality?

Knowing whether your patients will be inpatient, outpatient, at home, in a nursing home, or in an urgent or primary care setting will help you determine the potential acuity of the patient and whether the course of treatment will be short-term or longitudinal. Medical care can also be provided through a range of modalities from an e-consultation to a virtual visit.

Make sure that you feel comfortable providing care in the setting and treatment modality that your role would encompass and its associated liability.  

2. Will you be e-prescribing?

Consider which types of medications you feel comfortable e-prescribing and which medications will need follow up. Most telemedicine companies do not allow prescription of controlled substances due to the Ryan Haight Act, which dictates that a physician is required to see a patient face-to-face before prescribing a controlled substance and then every 24 months.

3. Will you be considered an Employee or an Independent Contractor?

If you are an employee, the employer will withhold income tax, social security, and medicare contributions from your wages but may also offer employment benefits – which may be less useful if you are practicing telemedicine from abroad. As an independent contractor, you will have greater ability to tax-deduct expenses related to your work with the company, but will not receive a benefits package from the company.

4. Is the patient population covered by Medicare, Medicaid, or private insurers?

This information can give you a sense of the demographics of the patient population. In addition, providers outside of the US are not eligible to bill Medicare/Medicaid. If you plan to live outside the US and practice telemedicine into the US, ensure that you will not be billing Medicare and Medicaid directly.

5. What is the compensation structure?

Different companies have different compensation models. For inpatient or emergency room care, some companies will pay you by the hour; while others will compensate you for each patient seen; and others will have a hybrid model.

For outpatient work, you’ll want to know how long ahead of time patients are scheduled, and if you are paid for no-shows.

Know your worth – don’t be afraid to negotiate.

6. Is there a minimal commitment?

Some companies require a commitment of a minimal number of hours per week or shifts per month, while others will have no such commitment. Know what you are getting yourself into.

7. Is Malpractice Insurance provided?

If the telemedicine company provides malpractice insurance, know whether it is a claims-made or occurrence policy. A claims-made policy provides coverage if the policy is in effect when the claim was made AND when a lawsuit was filed. Ideally a claims-made policy would provide “tail coverage” that extends coverage for a period of time after the policy has ended. Occurrence policies cover claims for an event that took place during the period of coverage – it does not require tail coverage. An occurrence policy is often more expensive and less frequently offered by employers.

8. In which states does the company provide clinical care?

This will dictate which state medical licenses you will need. It is also worth asking whether a company will reimburse you for obtaining new state medical licenses.

9. Do they allow providers to practice telemedicine from abroad?

This is a critical question for those interested in practicing telemedicine from abroad. There are some telemedicine companies which will not allow providers to be outside the US to stay within CMS Medicare/Medicaid regulations or the terms of the malpractice insurance. If the company does allow providers to be abroad, ensure that their telemedicine platform is accessible from outside the US or consider connecting through a VPN.

10. Talk to a physician who is already working with the company

Ask to speak with a physician already working for the company to get a better idea of the experience working for your potential new employer. You will want to know if support staff are responsive, how patient safety concerns are handled through the telemedicine platform, and whether you are paid appropriately/correctly on a timely manner.

Bottom Line

Make sure you are fully informed about the services and expectations of the telemedicine company. For those planning to practice telemedicine from abroad, be upfront and honest about your intention to do so.

Dr. Ashwini Bapat is a palliative care physician, Founder and CEO of EpioneMD, which provides virtual advanced care planning and serious illness coaching to individuals and telepalliative care consultation to healthcare organizations. She resides in Portugal.

For a personalized approach to moving abroad, learn about how our Guidance Service can help.

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