November 5, 2020
With increasing reliance on virtual care, providers should be conscious of the documentation requirements for a virtual care service to be compliant with CMS standards. Virtual care documentation requirements are similar to a face-to-face encounter, but include four additional elements:
- Statement indicating the telehealth service was provided using both audio and video modalities
- Location of the patient and the location of the provider
- Names of additional persons participating in the telemedicine visit and their role in the visit
- A statement indicating patient consent was given for the telehealth visit
For more information and examples of best-in-class documentation, review this guide.
Contact Providerclinicalconsultants@premera.com with any questions.