• Teleradiology is a growing field.x-ray image by Claudio Calcagno from Fotolia.com
  
  Teleradiology refers to the reading of radiological patient images at a remote location as opposed to on-site by a radiologist. This is a growing field due to the cost savings made possible by outsourcing such services to remote or under-utilized locations. The Medicaid program has cautiously approved of this new trend, though it places important restrictions on the provision of teleradiology services.
  
  

Preliminary and Final Reads

• A preliminary read is often used in emergent or emergency cases for diagnosis or treatment of a patient. As the name suggests, the reading takes place near the start of treatment for a patient. By contrast, a final reading usually occurs when building the patient records or creating a final billing record.
  
  

Teleradiology Reimbursement

• Medicaid requires that teleradiology services must be provided from within the United States, though there are exceptions for services purchased by Indian Health Services (IHS) providers. This is due to the requirement that teleradiologist must carry liability insurance and must be licensed. Medicaid cannot guarantee the licensure and qualifications of foreign-based physicians, and therefore will generally not reimburse such services.
  
  Medicaid is a joint federal-state program, but licensing is handled at the state level. Therefore each state will maintain its own rules regarding teleradiology reimbursement. Generally speaking, a state will require any physician reading scans be licensed within the specific state.
  
  In addition, there may be false claim or kickback concerns if an ordering physician wishes to bill for in-office ancillary services (which require the services be performed within an office).
  
  

Teleradiology Quality Measures

• A facility seeking to bill Medicaid for teleradiology services must comply with the requirements of the Medicaid program's conditions of participation. This is an important factor for final readings as these readings offer final interpretations, and thus implicate the licensing, training and certifications of the reading radiologists.
  
  The American College of Radiology has established practice guidelines in regard to teleradiology. While these practice guidelines do not have the effect of law, they provide important quality of care guidelines and will be referenced in a medical malpractice suit should one arise.
  
  Since patient scan images contain personal health information, there are significant data security concerns regarding teleradiology. Transmitting facilities must ensure proper network security and acceptable storage of images.