TABLE 4.

Summary of paediatric weight management clinic telemedicine practice prior and during COVID‐19 ^{13 , 25 , 29 , 26}

	Policy/regulatory standards	Authors experience	COVID‐19 impact
Technology	CMS TRC a	Institution telehealth administrative team chose	Same
Equipment	CMS TRC	Laptops, Tablets	Laptops, tablets, smart phones; The provider's platform and therefore patient encounter is HIPAA compliant regardless of what device the patient uses to enter the telemedicine platform.
Security	CMS TRC	HIPAA compliant platform, documentation in EMR, authentication and identification to ensure telemedicine confidentiality. Originating site confirms patient identification	HIPAA compliant platform, virtual waiting room of the professional license requires distant provider ‘accepts’ only identified patients into session, documentation in EMR, authentication and identification to ensure telemedicine confidentiality.
Providers eligible to offer telehealth services	CMS State Medicaid guidance b	All members of our team MD/DO/NP/RD/PhD	Same
Provider settings	Distant Site	Distant site‐team	Same
Patient settings	Originating Site (healthcare facility as outlined by CMS/State policies)	Originating site: Primary care healthcare office	Patient's home
Who needs to be present	AAP consent/assent guidelines 24	Patient and family members with guardian and patients consent/assent.	Same practice Ask who is present in the home; ask permission to speak freely
Health condition characteristics	CMS and State Medicare: Provider assesses if can address health condition using this modality	Obesity and related comorbidities. In‐person visit scheduled if concerns arise using virtual visit	Same
Scheduling	Institutional policy Clinic protocol	Our clinic schedules across the multi‐disciplinary team	Same
Registration	Institutional policy Clinic protocol	Registered by our clinic (Distant Site)	Registered by our clinic (Distant Site)
Consent for non‐in‐person visit	CMS State Medicaid Institutional policy	Pre‐COVID: obtained written consent to treat. Inform care by telemedicine voluntary	Per institution leadership/legal team verbal consent replicates written consent during the pandemic
Check in and out	N/A	Via our clinic (distant)	Via our clinic (distant)
Credentialing	CMS Board of Regulations for Providers Institution credentialing policies	Full credentialing of distant site provider by originating site Medical Staff Office if distant site provider will be seeing patients in‐person at the originating site	Provider already credentialed by distant site (their home institution); no further credentialing necessary as the originating site is now the patient's home.
Documentation	CMS Institution documentation policies	Document that visit occurred via telemedicine	Document if visit occurred via telemedicine, telephonic, or both
Coding and Billing	CMS Institutional policies	See Table 3	See Table 3
Facility fee	CMS Institutional policies	See Table 3 originating site Q3014	No Facility Fee when home is originating site
Professional fee	CMS Institutional policies	See Table 3 Distant Site: Professional Fee with GT or 95 modifier	Same

Abbreviations: CMS, Centers for Medicare and Medicaid Services; HIPAA, Health Insurance Portability and Accountability Act; TRC, National Consortium of Telehealth Resource Centers.

^aRestricted to HIPAA‐approved under CMS/TRC regulations.

^bEligible providers vary by state Medicaid policy. Rapidly changing.