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Overseas Tele-Intensivist

  • 1.  Overseas Tele-Intensivist

    Posted 05-06-2022 13:04
    Does anyone know of any restrictions (either from insurance companies, Medicare/Medicaid, or within their own organizations) which limit the use of an intensivist based outside the United States in providing care and billing for care to patients located within the United States?

    Thank you in advance!

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    Amay Parikh
    AdventHealth Critical Care at Central Florida
    Orlando FL
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  • 2.  RE: Overseas Tele-Intensivist

    Posted 05-06-2022 16:31
    There are companies that provide just that

    Ahmed Badr, MD, FACS


    Original Message


  • 3.  RE: Overseas Tele-Intensivist

    Posted 05-06-2022 20:26
    This is super-interesting. Do we have any data/impression which market segment they cater too (rural? city? small vs big hospitals?)? How many companies are out there? I know of one...

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    Krzysztof Laudanski
    Department of Anesthesiology & Critical Care
    Physician Lead for Quality and Implementation Penn eLert
    University of Pennsylvania
    Philadelphia PA
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    Original Message


  • 4.  RE: Overseas Tele-Intensivist

    Posted 05-07-2022 07:06
    There is a one in Israel that supports Seattle area. another one in India that is providing service to St Lois area.  However, the provider must have a valid license in US and must work some time in US per year



    Original Message


  • 5.  RE: Overseas Tele-Intensivist

    Posted 05-07-2022 08:07
    @Subhash Patel Does the work location requirement placed on the physician (i.e. working for some time in the US) come from the state, company, or insurance companies?

    Each state has its own legislation regarding obtaining and maintaining a medical license (and sometimes specific to telemedicine).​  Have you seen any other licensure barriers?

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    Amay Parikh
    AdventHealth Critical Care at Central Florida
    Orlando FL
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    Original Message


  • 6.  RE: Overseas Tele-Intensivist

    Posted 05-07-2022 08:49
    I believe that comes from the Institution that is contracting the service.  I am not sure



    Original Message


  • 7.  RE: Overseas Tele-Intensivist

    Posted 05-07-2022 08:12
    @Ahmed Badr What barriers (medical staff, legislative, etc) do those companies face in providing physicians from overseas to care for patients in the United States?​

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    Amay Parikh
    AdventHealth Critical Care at Central Florida
    Orlando FL
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    Original Message


  • 8.  RE: Overseas Tele-Intensivist

    Posted 05-07-2022 08:36
    We have overseas physicians ( India, phillipines, Australia)  from remote ICU providing care for a few years.They have US board certification, carry state licenses & are part of medical staff so no barriers.

    Rakesh Alva 

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    Original Message


  • 9.  RE: Overseas Tele-Intensivist

    Posted 05-09-2022 19:51
    Great question. Thanks for thinking of it

    I've been involved with TeleNeurocrit gigs that required me to be physically located in the US of A (which includes by the way beautiful locales like Hawaii, USVI and Puerto Rico). My understanding is that this is a CMS requirement for billing

    Have also done TeleNeurocrit from outside the US, and my understanding is that the group I did it for was receiving a subscription fee from the hospitals and there was no billing involved

    All of this is word of mouth. It'll be nice to read this from the horse's mouth. Any thoughts of where to even look up this?

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    Darwin Ramirez ABreu
    St Louis Park MN
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    Original Message


  • 10.  RE: Overseas Tele-Intensivist

    Posted 05-10-2022 06:29
    Good morning everyone,

    Dr. Ramirez Abreu is essentially correct.  In fact, there was a recent court case regarding this very issue: https://mhealthintelligence.com/news/doctors-outside-us-cannot-bill-medicare-for-telehealth-court-confirms.

    Sincerely,
    Israel Villanueva, MD, MBA, FCCP, CHCQM
    Chief Medical Officer
    Intercept Telemed, Inc.
    2200 N. Commerce Parkway
    Suite 200
    Weston, FL 33326






    Original Message


  • 11.  RE: Overseas Tele-Intensivist

    Posted 05-10-2022 06:30
    And as a further comment, private insurance companies and other third party payors usually follows CMS guidelines….


    Original Message


  • 12.  RE: Overseas Tele-Intensivist

    Posted 05-10-2022 12:18
    We have been through this at our own health system. TCC services can be billed as long as the provider is in the US, unfortunately, overseas TCC providers can't bill. It doesn't make sense, and letters were written to Medicare by the overseas TCC providers and no response. Implications of this rule are not easy to figure out for several reasons: 
    • TCC services billing waiver might expire anytime
    • TCC billing overseas might be allowed in the future
    • Overseas TCC services are needed and the demand is high
    • It is not clear if TCC services by APPs from within the US is an alternative to overseas TCC services. 

    Happy to zoom in on this topic in out next KEG webinar, I'm looking for experts on the matter. Please let me know if you know any.

    Majdi

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    Majdi Hamarshi
    Critical Care
    Saint Lukes Health System - Kansas City, MO
    Kansas City MO
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    Original Message


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