Medical providers are finding new ways to connect with patients. Telemedicine offers the opportunity to provide remote healthcare services to injured workers and has become an increasingly important topic in workers’ compensation. With the COVID-19 pandemic, telemedicine has gained a foothold as a viable option for treating workers’ compensation patients. Injured workers can schedule a virtual visit with their physicians, utilizing video and audio platforms, and this helps ensure uninterrupted treatment, keeps claims moving forward, all while avoiding the risks of an in-person visit. Many workers’ compensation doctors view telemedicine as a safe option for both themselves and their patients, and we are seeing an increasing number of office visits occurring through these virtual appointments.
The California Division of Workers’ Compensation previously confirmed Medical Provider Network (MPN) physicians may treat patients via telehealth. While an MPN program is not required in order to offer telemedicine services, MPN providers in the network are able to provide this service if they have all the necessary equipment to complete the examinations.
Further, due to COVID-19, Workers’ Compensation boards in many states have temporarily lifted restrictions on tele-rehabilitation, and medical providers are beginning to offer this service to their injured workers. Many of our outpatient providers are also extending virtual encounters to include physical and occupational therapy.
More recently, the Office of Administrative Law approved emergency rules to allow remote medical-legal evaluations when the following criteria are met:
- The employee doesn’t have to travel outside his or her home to attend the examination.
- The case involves a dispute over injury arising out of, or occurring in the course of, employment (AOE/COE), termination of temporary disability benefits, or work restrictions.
- All parties to the case agree to the Panel Qualified Medical Examination (PQME) proceeding by telemedicine.
- The PQME issues a written statement that a physical examination of the employee is not necessary for the evaluation.
While the benefits of providing telehealth during the pandemic are numerous, there is potential insurance fraud associated with telemedicine as well. As most states have promoted telemedicine for injured workers and other patients who do not want an in-person visit, unethical medical providers and telemarketing firms have learned how to exploit the system. New billing codes have been added for telephone and video conference medical examinations. Insurers still have work to do as telemedicine insurance fraud criminals are counting on an insurer’s failure to fully understand the new telemedicine billing codes.
Regardless, telemedicine is here to stay. Through this service, injured workers have immediate access to care, which can cut down on wait times, temporary disability spend, and medical mileage and treatment costs. Injured employees have the flexibility to set their appointments as needed within the work day and can receive treatment at the workplace, allowing for near-immediate return to work.
Athens is here to assist. Please feel free to reach out should you have any questions about telemedicine.