Want to admire Roman aqueducts on your morning run, pluck pomegranates from your backyard, and see patients in the US – all on the same day? Telemedicine can help you do just that!
Here are six things to know about practicing telemedicine while abroad.
1. Know About Health Insurance Reimbursement
Physicians are ineligible to bill Medicare if located outside of the United States during the patient encounter. Medicaid telehealth regulations are specific to each state, so check with your state’s Medicaid administrator if it is possible to bill Medicaid while residing abroad. Some Private insurance companies, like Optum, will allow physicians on their panel to be outside the US. Healthcare systems that do not bill Medicare may allow you to work outside the US.
2. Avoid Prescribing Controlled Substances
According to the Ryan Haight Act, a provider may prescribe controlled substances via telemedicine to a patient as long as the physician has seen the patient at least once in person in the prior 24 months. This in-person evaluation is not required during a public health emergency.
Per DEA regulations, physicians are ineligible for DEA registration if they are located outside of the United States. Per my communications with the DEA, one possible interpretation of this regulation is that prescribing controlled substances from abroad is forbidden.
3. Ensure Your Malpractice Insurance Covers Practicing Telemedicine While Abroad
Malpractice insurers may not cover you if you are practicing telemedicine from abroad. This is partly because insurance is based on spreading individual risk across a population. That said, some malpractice insurers will cover you while residing abroad.
4. Consider Obtaining Multiple State Licenses
Multiple state licenses will likely be required to work with a telemedicine company, as physicians are only legally allowed to practice in states where they are licensed. Most state medical boards allow physicians outside the US to see patients in their state through telemedicine but be sure to double-check with your state’s medical board.
Consider getting a license in one of the more populous states which will likely have higher telehealth utilization: California, New York, Texas, Florida. Also consider obtaining a license in an Interstate Medical License Compact State – the compact includes 34 states and streamlines licensure in other member states if you meet the eligibility criteria.
5. Difficulty Accessing an Electronic Medical Record (EMR)
Some US-based EMRs do not allow foreign IP addresses to access their records. A VPN can circumvent this problem and can help access other personal resources such as a US-based bank account and of course, your US Netflix account. Some physicians go on a scouting trip to their destination of interest to ensure they can access their EMR from outside the US.
6. Some Telemedicine Companies Allow Physicians to Be Abroad
Some telemedicine companies allow physicians to work from abroad. These companies typically contract with payers, healthcare systems, or employers that do not utilize Medicare for reimbursement and will not object to you working outside the United States. For physicians who are not US citizens or US Green Card holders, here is a guide to help navigate practicing telemedicine abroad.
Check out our list of telemedicine companies that allow you to work from abroad (and those that don’t). Also, visit our Job Board for the latest open positions and join our Facebook group for more information!
Bottom Line
Practicing telemedicine abroad is possible if you can overcome the challenges. It’s very important to be upfront with your employer and/or your private patients about the fact that you plan to work from outside the US.
Originally published August 28th, 2020.
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.
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