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technology must be able to provide, at a minimum, the same information to the provider which will enable them to meet or exceed the prevailing standard of care.• Controlled substances shall not be prescribed through the use of telemedicine except for the treatment of psychiatric disorders. This provision does not preclude physicians from ordering controlled substances through the use of telemedicine for patients hospitalized in a facility licensed under Ch. 395, F.S.• Prescribing medications based solely on an electronic medical questionnaire constitutes the failure to practice medicine with that level of care, skill, and treatment which is recognized by reasonably prudent physicians as being acceptable under similar conditions and circumstances, as well as prescribing legend drugs other than in the course of a physician’s professional practice.• Providers of telemedicine shall not provide treatment recommendations, including issuing a prescription, via electronic or other means, unless these elements have been met:o A documented patient evaluation, including history and physical examination to establish the diagnosis for which any legend drug is prescribed.o Discussion between the provider and the patient regarding treatment options and the risks and benefits of treatment.o Maintenance of contemporaneous medical records.• The practice of medicine by telemedicine does not alter any obligation of the physician or the P.A. regarding patient confidentiality or recordkeeping.• A physician-patient relationship may be established through telemedicine.This rule does not apply in the following circumstances:• Consultations between physicians or the transmission and review of digital images, pathology specimens, test results, or other medical data.• Emergency medical services provided by emergency physicians, emergency medical technicians (EMTs), paramedics, and emergency dispatchers.• When a physician or P.A. is treating a patient with an emergency medical condition that requires immediate medical care.This article is presented for educational purposes only and should not be taken as a substitute for legal advice, which should be obtained from personal legal counsel. Nevertheless, the FMA hopes that the information provided here and in its other publications continues to assist physicians in answering many of their most common legal questions allowing them to treat patients, instead of addressing legal concerns. Last Update: August 2016 PRESCRIPTION RENEWALS In the course of a physician's normal practice, it is common for the physician to treat patients whose conditions require continuous medication, while not necessitating actual repeated office visits to the practitioner. In these instances, expediency dictates that the physician merely renew prescriptions of the needed medication without wasting the time of the patient or physician by scheduling an office visit. In addition, the physician, having a desire to be compensated for the ongoing care of the patient, is tempted to code the service in such a way that the physician will be reimbursed by the patient or third party payors for his services. In many instances, the physician will bill this service as an office visit, notwithstanding the practitioner's failure to have personally examined the patient.Unfortunately, the practice of charging for routine renewing of prescriptions exposes the physician to a myriad of legal and ethical problems. Although it is appropriate for a physician to charge a nominal fee for renewing prescriptions, several factors must be considered before the physician renews any medication, especially if the physician wishes to charge for this service.Even if the physician chooses not to charge, the prescription of any medication without an office visit, even one which previously has been administered without incident to the patient, poses several practical concerns for the physician. For instance, courts in many states have found that physicians who routinely call in prescriptions for patients without actually examining the patients may be found guilty of excessive prescribing and prescribing outside the course of their practices, both of which would be a violation of Section 458.331(1)(m), Florida Statutes, (see e.g., Eaves v. Board of Medical Examiners, 467 N.W.2d 234 (Iowa 1991) see also U.S. v. Moore, 423 US 122(1975)) and could result in the loss of the physicians' licenses. In addition, the granting of prescriptions without actual examination exposes the physician to the threat of a malpractice action for which the physician would have little defense, as an actual examination was not made to support the doctor's prescription.Nor is a physician immune from malpractice and overprescription claims due to the physician's reliance on the opinion of another medical professional. For instance, a locum tenens physician may not assume that a prescription made by the absent physician should be renewed. Rather, the covering physician should examine the medical record to determine if the prescription is suitable for a chronic condition which is unlikely to change before renewing a prescription for such medication. If, however, the prescription for which a renewal is asked is for a condition which may have abated since the issuance of the original prescription, the locum tenens should require an office visit by the patient before renewing the prescription.The potential problems are multiplied when a physician charges for this service. In fact, in addition to the potential pitfalls noted above, physicians who routinely prescribe controlled substances to patients while charging a flat fee for such prescriptions have been found guilty of trafficking in narcotics (see e.g. U.S. v. Larsen, 507 F.2d 385 (9th Cir. 1974)) and sentenced as felons.From an ethical perspective, the practice of charging an amount equal to that of an office visit for the mere prescribing of a drug could well be viewed as unethical under standards prescribed by the American Medical Association Council on Ethical and Judicial Affairs. Under the AMA's Council on Ethical and Judicial Affairs Opinion 6.05, "[a] fee is excessive when after review of the facts a person knowledgeable to the current charges made by physicians would be left with a definite and firm conviction that the fee is in excess of a reasonable fee." In determining whether a fee is excessive, the trier of fact would be asked to consider "the difficulty and/or uniqueness of the services performed, and the time, skill and experience required." Obviously, in the case of the routine filing of a prescription, the time and skill required would only justify a minimal fee. In most cases, the imposition of a charge equal to a full office visit may well be considered excessive.As shown above, for purposes of quality medical care and ethics, it is unadvisable for a physician to charge a patient for an office visit when the only service offered is the renewing of a prescription. Yet the problems associated with such a practice are compounded when a third party payor is involved. The most common problem associated with such a practice is that of "upcoding". In a typical "upcoding" scenario, a physician, in an effort to be reimbursed, may well attempt to bill for a prescription renewal under CPT-4 code 90040 (brief examination or treatment). In actuality, however, such services should be coded as no more than 90030 (minimal service), as the latter CPT code does not require the actual examination by a physician. Such differences may seem trivial, but they certainly were not trivial to a Dr. Larm, whose upcoding of this type resulted in criminal charges being filed against him by Medicare, charges for which he has found guilty and which were upheld by federal appeals courts (see U.S. v. Larm, 824 F.2d 780, (9th Cir. 1987)).Just as importantly, the practice of billing an insurance company for an office visit which did not, in fact, occur would constitute insurance fraud under Section 817.234, Florida Statutes. Under this statute, any physician who asks for reimbursement by providing the insurer with false