TeleNephrology Certification Program

TeleNephrology Certification Program

This comprehensive 24-week certification program prepares nephrologists and advanced practice providers to deliver specialized kidney care through telehealth modalities. With over 300 indexed topics covering clinical knowledge, technology integration, compliance, and practice management, graduates will be equipped to launch or enhance a virtual nephrology practice with confidence. The program combines theoretical knowledge with practical skills through weekly micro-modules, live labs, case conferences, and practice-building sprints, culminating in a capstone project that demonstrates mastery of tele-nephrology principles and readiness for practice.

The TeleNephrology certification program begins with a comprehensive orientation that sets expectations and provides the structural framework for your learning journey. This initial phase ensures all participants understand the program's scope, delivery methods, and support systems available throughout the 24-week curriculum.

1 Program Welcome and Expectations
An introduction to the program's goals, learning methodology, and expected outcomes. Participants receive a comprehensive overview of the skills and knowledge they will develop over the 24-week journey, along with performance metrics and milestones.

2 Schedule Structure
Detailed breakdown of the weekly workload, which includes 2-4 micro-modules, live laboratory sessions, interactive case conferences, and dedicated practice-building sprints. Each week builds on previous content to create a comprehensive learning progression.

3 Cohort Calendar
Overview of the seasonal enrollment cycles, with specific application deadlines, orientation periods, and program dates for each cohort throughout the year.

4 Support Channels
Introduction to the available communication channels, including program website, dedicated email support, and phone assistance for technical or administrative questions.

The enrollment process follows a structured four-step approach designed to ensure appropriate candidate selection and preparation:

Online Application: Prospective students complete an application form at www.Telehealth.school/apply, providing professional credentials, experience, and practice goals.

Consultation Call: A personalized discussion to determine eligibility, select the appropriate program track, and address any specific questions or concerns.

Enrollment Confirmation: Upon acceptance, participants complete documentation requirements and receive access credentials for the learning platform.

Program Commencement: Full access to program materials is granted according to the cohort schedule, beginning with orientation activities.

Program Structure
The program is designed to provide personalized attention through limited cohort sizes, ensuring each participant receives adequate support from faculty and peers. Before beginning, all students complete a technology readiness assessment to confirm their hardware, software, and connectivity meet the requirements for successful participation in virtual learning activities and telehealth practice.

Professional conduct standards, attendance requirements, and academic integrity guidelines are clearly defined at the outset. Participants are organized into peer groups for collaborative learning, with access to faculty mentoring and scheduled office hours for individualized support.

The program culminates in a capstone project that serves as the summative assessment of each participant's readiness to implement tele-nephrology in practice. Comprehensive job placement services and practice launch support are provided to facilitate immediate application of program learnings in clinical settings.

Flexible policies regarding withdrawals, deferrals, and financial assistance ensure that participants can navigate unexpected circumstances without losing their investment in professional development.

A solid understanding of telehealth's evolution and fundamental principles is essential for specialists implementing virtual kidney care. This module explores the historical development, evidence base, delivery modalities, and core competencies that form the foundation of effective tele-nephrology practice.

Telehealth has evolved significantly since its inception, with several key inflection points accelerating its adoption and technological advancement. This section examines this evolution and the growing body of evidence supporting telehealth's effectiveness in various clinical contexts.

Key Historical Developments
Early radio consultations for maritime and remote medical care
Development of closed-circuit television systems for psychiatric care (1950s-1960s)
NASA's contributions to remote monitoring technology (1960s-1970s)
Internet-enabled telehealth platforms (1990s-2000s)
Smartphone revolution expanding access (2010s)
COVID-19 pandemic causing unprecedented telehealth expansion (2020)

Evidence for Effectiveness
Comprehensive reviews by the Agency for Healthcare Research and Quality (AHRQ), American Telemedicine Association (ATA), and Department of Health and Human Services (HHS) have demonstrated telehealth's clinical efficacy, with particular strengths in:
- Chronic disease management, including kidney disease
- Post-hospitalization follow-up and reduced readmissions
- Patient satisfaction and engagement
- Rural and underserved population access
- Cost-effectiveness for specific conditions and contexts

Synchronous Care
Real-time video or audio interactions between providers and patients, enabling immediate assessment, diagnosis, and treatment recommendations. In nephrology, this is particularly valuable for follow-up visits, medication adjustments, and urgent triage of symptoms.

Asynchronous Care
Store-and-forward technologies allowing patients to submit information (images, lab results, symptoms) for later review by the nephrologist. Useful for stable CKD monitoring, laboratory result review, and non-urgent consultations.

Remote Patient Monitoring (RPM)
Continuous or intermittent collection of patient-generated health data through connected devices. Essential for tracking blood pressure, weight, glucose, and other vital parameters in kidney patients.

eConsult
Provider-to-provider consultations regarding specific patient cases. Enables nephrologists to guide primary care physicians in CKD management without requiring formal patient referral.

Telehealth Physical Examination Techniques: Modified examination approaches that maximize assessment capabilities through video, including techniques for evaluating edema, access sites, and general appearance.

Patient Selection and Triage: Protocols for determining which kidney patients are appropriate for virtual care versus those requiring in-person evaluation.

Building Rapport and Equity: Strategies for establishing therapeutic relationships through digital interfaces while ensuring equitable access for all patient populations.

Informed Consent: Processes for obtaining and documenting patient understanding and agreement to telehealth services, including limitations and alternatives.

Documentation Standards: Guidelines for comprehensive and compliant documentation of virtual encounters, emphasizing elements unique to telehealth.

Tele-prescribing: Requirements for electronic prescribing, including controlled substances regulations, PDMP integration, and best practices for medication management.

Cross-state Practice: Licensure requirements for providing care across state lines, available interstate compacts, and payer policy variations that affect reimbursement.

Quality and Safety Frameworks: Standards for ensuring high-quality, safe telehealth care, including risk assessment, monitoring, and continuous improvement processes.

Malpractice Considerations: Liability risks specific to telehealth practice and strategies for mitigation through appropriate policies, procedures, and documentation.

Closing Care Gaps: Strategies for leveraging telehealth to improve access for rural populations, home dialysis patients, and nursing home residents with kidney disease.

Tele-nephrology Care Pathways: Structured approaches for managing various kidney conditions through telehealth, including acute kidney injury, chronic kidney disease, dialysis monitoring, and transplant follow-up.

A thorough understanding of the complex regulatory environment surrounding telehealth is essential for establishing a compliant tele-nephrology practice. This module covers the critical regulatory frameworks that govern telehealth delivery, data protection, information exchange, and billing practices.

HHS Telehealth Policy
HHS provides comprehensive guidance on telehealth implementation, including coverage of current flexibilities, limitations, and evolving federal perspectives on virtual care delivery. Understanding this framework is essential for navigating the changing regulatory landscape and ensuring compliance with federal requirements.

HIPAA Privacy Rule
The Privacy Rule establishes national standards for the protection of individually identifiable health information. In telehealth, this includes requirements for patient authorization, minimum necessary disclosures, and appropriate safeguards during virtual encounters, messaging, and information sharing.

HIPAA Security Rule
The Security Rule focuses specifically on electronic protected health information (ePHI), requiring administrative, physical, and technical safeguards. For tele-nephrology practices, this necessitates risk analysis, implementation of appropriate security measures, and establishment of business associate agreements (BAAs) with technology vendors.

Breach Notification
This rule requires covered entities to notify affected individuals, HHS, and in some cases, the media following a breach of unsecured protected health information. Tele-nephrology practices must develop incident response protocols to address potential data breaches in virtual care environments.

Minimum Necessary Standard: Guidelines for limiting the disclosure of protected health information to the minimum necessary for care coordination, particularly important in virtual consultations and referrals.

HITECH Act: The Health Information Technology for Economic and Clinical Health Act established incentives for the adoption of electronic health records and strengthened HIPAA enforcement, with significant implications for telehealth practices.

ONC Cures Act Final Rule: Regulations addressing information blocking and promoting interoperability, ensuring patients have appropriate access to their health information across digital platforms.

TEFCA: The Trusted Exchange Framework and Common Agreement establishes principles for nationwide health information exchange, affecting how tele-nephrology practices share data with other providers.

OIG Compliance Essentials
Developing effective compliance programs for small telehealth practices
Implementing regular self-auditing procedures
Establishing clear policies and procedures
Conducting staff training on compliance requirements
Responding appropriately to detected offenses

Key Risk Areas
Billing integrity for virtual services
Appropriate documentation of time-based codes
Avoiding improper patient inducements
Managing vendor relationships compliantly
Preventing kickbacks in referral arrangements

OSHA for Telehealth: Occupational Safety and Health Administration requirements applicable to outpatient telehealth settings, including hazard assessments and ergonomic considerations.

Bloodborne Pathogens: Standards for protection against exposure during in-person components of hybrid care models.

Workplace Safety: Guidelines for ensuring safety in distributed healthcare teams and home office environments.

ADA Compliance: Requirements for making telehealth platforms and services accessible to patients with disabilities.

Cultural and Linguistic Access: Standards for providing interpreter services and culturally appropriate care in virtual settings, in accordance with Section 1557 requirements.

Health IT Certification: Understanding the ONC certification program and its requirements for electronic health record systems used in telehealth.

Cybersecurity Basics: Essential security practices including protection against phishing, implementation of multi-factor authentication, and device hardening procedures.

Audit Logging: Requirements for maintaining comprehensive logs of system activity, access to patient information, and other security-relevant events.

Data Ethics: Considerations regarding algorithmic bias, artificial intelligence safety, and ethical use of patient data in digital health tools.

Ryan Haight Act
Drug Enforcement Administration (DEA) requirements for prescribing controlled substances via telemedicine, including current flexibilities and permanent framework provisions.

CMS Telehealth Coverage
Centers for Medicare & Medicaid Services rules regarding covered telehealth services, appropriate place of service coding, and reimbursement policies for virtual care.

Commercial Payer Policies
Understanding the varied requirements in commercial insurance contracts regarding telehealth coverage, documentation, and billing practices.

Maintaining compliance in tele-nephrology requires ongoing vigilance and systematic approaches to regulatory monitoring. Practitioners should establish a compliance calendar with regular review cycles and maintain comprehensive training records to demonstrate due diligence in meeting all applicable requirements.

Electronic health record (EHR) systems serve as the foundation for virtual kidney care, requiring careful configuration to support telehealth workflows and nephrology-specific data needs. Effective optimization includes creating customized templates for virtual visits, developing order sets for common kidney conditions, implementing decision support tools for renal dosing, and establishing efficient documentation workflows that capture telehealth- specific elements while minimizing clinician burden.

The integration of telehealth platforms with EHR systems is critical for maintaining comprehensive patient records. This includes seamless launching of video visits from the EHR, automatic documentation of encounter metadata, and incorporation of patient-generated health data into the clinical record. Practice-specific optimization should focus on nephrology requirements such as GFR tracking, proteinuria monitoring, and dialysis-related documentation fields.

EHR System — Central clinical record and exchange hub
Patient Devices — Home monitors send vitals and alerts
Laboratories — Lab results integrated in real time
Imaging Centers — Imaging data shared via standards
Other Providers — Referrals and consults exchange data

Modern healthcare requires seamless information exchange between systems, particularly for specialty care that depends on coordinating with multiple providers and data sources. Interoperability standards and technologies that support tele-nephrology include:

HL7 and FHIR APIs: Understanding HL7 and Fast Healthcare Interoperability Resources (FHIR) APIs that enable data exchange between systems. SMART-on-FHIR apps provide specialized kidney care functionalities.

Laboratory and Imaging Integration: Implementing eOrders and eResults interfaces with laboratories and imaging centers to ensure timely receipt of kidney function data, including creatinine, electrolytes, and urinalysis.

Device Integration: Selecting and configuring remote patient monitoring devices (BP cuffs, scales, glucometers, home urinalysis) that transmit data to clinical systems.

Special consideration must be given to implementing the race-free 2021 CKD-EPI equation for eGFR.

Data Quality & Reconciliation: Ensure accuracy and completeness of clinical data from multiple sources, with attention to laboratory standardization and home-collected measures.

Risk Stratification: Algorithms to identify patients at highest risk for CKD progression.

Predictive Modeling: Tools for AKI detection/prediction, integrated into workflow with realistic expectations.

Population Health: Registries and panel management for quality metrics.

Longitudinal care planning is enhanced through tracking of education and interventions, with digital tools supporting personalized kidney care plans shared via portal.

Synchronous Care Workflows
Tele-rounding protocols, structured video templates, tele-triage, and escalation pathways.

Asynchronous Care Workflows
Secure messaging frameworks, portal education and symptom monitoring, eConsult processes, and closed-loop referral systems.

Standards for image/video capture are important for edema, access sites, and other visuals in nephrology.

Business Intelligence: KPIs and operational metrics for quality and strategy.

Backup and Recovery: Regular backups, disaster recovery, continuity for telehealth.

Device Management: Asset inventories, updates, patches.

Vendor Management: DUAs, BAAs, risk assessments.

Audit Preparedness: Systems for HIPAA/OIG/payer/accreditation readiness.

Research considerations: de-identification, IRB, ethics for secondary use of data. PGHD governance: ownership, retention, validation, and clinical incorporation.

Glomerular filtration, tubular function, acid-base regulation, and fluid-electrolyte homeostasis underpin remote kidney care interpretation.

Laboratory Interpretation
Urinalysis: Home collection guidance and remote interpretation; identify findings needing in-person evaluation.
Proteinuria Quantification: Spot ratios, 24-hour collections, biomarkers; home collection protocols where appropriate.
Kidney Function Assessment: eGFR equations (race-free 2021 CKD-EPI), creatinine kinetics for tracking function.

Metabolic Assessment
Acid-Base Interpretation: Analyze disturbances via telehealth; ordering ABG when needed.
Electrolyte Evaluation: Thresholds for intervention vs observation.
Mineral Metabolism: Calcium, phosphorus, PTH, vitamin D monitoring with appropriate intervals.

Blood Pressure Monitoring
Home BP device selection, technique guidance, structured reporting, continuous monitoring, alerts, and responses.

Volume Status Assessment
Visual JVD via video, facial/periorbital edema, self-exam of lower extremity edema with grading scales.

Access Site Evaluation
Remote inspection of dialysis access with positioning, lighting, and indicators of dysfunction/complications requiring in-person care.

Define “red flags” necessitating urgent in-person evaluation.

Imaging Selection: Evidence-based algorithms for choosing kidney imaging and interpretation workflows.

Biopsy Indications: Referral criteria, virtual prep, and result discussions via telehealth.

Risk Stratification: Acuity and complexity categorization with escalation pathways.

Medication Reconciliation: Comprehensive medication review, high-risk nephrotoxins, deprescribing strategies.

Renal Dosing: Adjustments across drug classes based on eGFR; verification workflows.

Nephrotoxin Management: Identification and stewardship for contrast, antibiotics, NSAIDs, etc.

Virtual approaches for dialysis initiation vs conservative management, with inclusion of family/caregivers. Use of visual decision aids and documentation of preferences and advance care plans.

Tele-nephrology offers a comprehensive platform for diagnosing, managing, and co-managing a wide spectrum of kidney conditions. While certain aspects of care may require in-person evaluation or procedures, many kidney diseases can be effectively addressed through virtual care with appropriate protocols and referral pathways.

Diabetic Kidney Disease
Monitor BP control, glycemic management, proteinuria quantification, and therapies including SGLT2 inhibitors and finerenone.

Hypertensive Nephrosclerosis
Remote BP monitoring, medications, lifestyle; frequent telehealth adjustments.

Primary Glomerulonephritis
IgA nephropathy, membranous, MCD, FSGS co-management via telehealth for immunosuppression monitoring and surveillance.

Autoimmune-Associated Nephritis
Lupus, ANCA vasculitis, post-infectious GN monitored virtually with clear triggers for in-person evaluation.

Also: C3 glomerulopathy, amyloidosis, MGRS, cryoglobulinemic GN; genetic conditions like thin basement membrane nephropathy and Alport syndrome benefit from telehealth-enabled subspecialty access and family-based discussions.

Drug-Induced Nephropathies: Telehealth for medication review, monitoring, and adjustments.

Systemic Disease Manifestations: Sarcoid, Sjögren's, myeloma, HIV, hepatitis co-managed virtually.

Post-Infectious Monitoring: AIN or COVID-related kidney injury follow-up via telehealth.

ADPKD: Monitor function, BP, cyst complications, consider tolvaptan; family screening and imaging review virtually.

Other Cystic/Genetic: Simple cysts, TSC, ARPKD, medullary cystic disease, Fabry—support genetic counseling and monitoring.

Calcium Stones: Metabolic evaluation, dietary counseling (calcium/oxalate/fluid), thiazides/citrate as indicated.

Other Stones: Uric acid (alkalization), cystine (thiol agents), struvite (infection control), with labs.

Metabolic Evaluation: 24-hour urine studies; telehealth review and targeted interventions.

Post-procedural prevention programs after lithotripsy/URS/PCNL fit telehealth models. For obstruction, telehealth triage and post-intervention recovery monitoring are effective.

Stage 1-5: Telehealth enables staging, progression tracking, and targeted interventions to slow progression.

CKD Complications: Anemia, mineral bone disorder, acidosis, uremic symptoms via virtual assessment/treatment.

Transition Planning: Shared decision-making for dialysis vs conservative management; virtual education and RRT preparation when chosen.

The module continues with dialysis monitoring, transplant care, AKI, electrolytes, pregnancy, pediatrics, and syndromes, each with virtual techniques and escalation indicators.

Home Hemodialysis Monitoring: Remote review of parameters, BP, weight, symptoms; troubleshoot and adjust prescriptions.

Peritoneal Dialysis Support: Monitor clearance, UF volumes, exit sites by video; modify PD prescriptions and surveillance.

Comprehensive ESRD Visits: Virtual monthly comprehensive visits with meds, labs, symptoms, and coordination.

Access Surveillance: HD video to assess infection/stenosis/dysfunction; protocols for in-person evaluation triggers.

Manage volume/BP, PD exit site, triage cramps/hypotension/hyperkalemia, patient education on fluid, diet, medication adherence.

Pre-Transplant: Education, risk factor modification, evaluation coordination, mental preparation.

Post-Transplant: Labs, immunosuppression adherence/management, rejection triage, BK/CMV monitoring, CV risk factors.

Stable transplant recipients benefit from telehealth; frequent monitoring during high-risk periods with less travel burden.

Post-Hospital Follow-up: Close monitoring, residual dysfunction assessment, strategies to prevent progression.

AKI Differentiation: Pre-renal vs intrinsic vs post-renal via history, lab trends, imaging coordination.

Special Scenarios: Rhabdo recovery, contrast-associated AKI, with prevention education.

Sodium Disorders (134-145): Hyponatremia/hypernatremia evaluation, volume status, meds, diet, correction monitoring.

Potassium (3.5-5.0): Hypo/hyperkalemia monitoring, meds, diet, binders; frequent labs.

Calcium (8.5-10.5): Hyper/hypocalcemia causes, symptoms, treatment; PTH and bone health monitoring.

Also phosphorus, magnesium, metabolic acidosis/alkalosis, RTA with virtual protocols and escalation indicators.

Pregnancy-Related: Co-manage preeclampsia, pregnancy proteinuria, hyperemesis-induced kidney injury.

Pediatric: Minimal change disease, pediatric stone prevention with family-centered care.

Overlap Syndromes: Cardiorenal, hepatorenal, resistant HTN with specialty coordination.

Telehealth Triage Approach
Telehealth Appropriate vs In-Person Needed protocols as listed (stable chronic care, meds adjustments, education vs urgent symptoms, new concerning findings, procedures, significant vital abnormalities, complex deterioration).

RAAS Blockade: Virtual initiation, home BP, labs, dose titration for proteinuria reduction and side effect management.

SGLT2 Inhibitors: Selection by GFR/albuminuria, education (mycotic infections, ketoacidosis risk), monitor volume status.

Nonsteroidal MRAs: Finerenone with lower hyperkalemia risk; potassium monitoring and coordination with RAAS therapies.

GLP-1 RAs: Cardiorenal benefits beyond glycemia; GI symptom monitoring, weight tracking, integrated diabetes care.

Fluid & Electrolytes: Loop/thiazide/combination diuretic strategies with weight and electrolytes monitoring; potassium binders (patiromer, SZC); bicarbonate for acidosis.

Mineral & Bone: Phosphate binders; nutritional/active vitamin D; calcimimetics with GI tolerance and biochemical monitoring.

Also anemia (ESAs, iron), uric acid management, pruritus, restless legs, uremic symptoms.

Steroids: Efficacy/adverse effects monitoring (glycemia, BP, bone health, cushingoid features).

CNIs: Tacrolimus/cyclosporine levels, dosing, nephrotoxicity surveillance.

Antimetabolites: MMF/azathioprine with CBC monitoring, GI symptoms, infections.

mTOR Inhibitors: Sirolimus/everolimus for wound healing, ulcers, hyperlipidemia, proteinuria.

Renal Dosing, Drug Interactions, Special Populations, Adherence, Deprescribing
Antibiotics with renal dosing; anticoagulation (DOACs/warfarin) with CKD adjustments; pain management avoiding nephrotoxins; cardiovascular meds with kidney interactions. Consider pregnancy safety and pediatric weight-based dosing/family involvement.

Comprehensive Review: Pill bottle screen-share, full med/supplement/OTC inventory.

Drug Interaction Detection: Timing/separation strategies for immunosuppressants, antihypertensives, etc.

Polypharmacy Mitigation: Telehealth deprescribing initiatives.

Adherence Technologies: Digital reminders, apps, remote monitoring, portal reinforcement.

Collaborative Management: Remote MTM with pharmacists; renal dosing references; standardized education scripts for high-risk meds.

PLADO: Plant-predominant kidney-focused approach; virtual cooking demos, shopping guidance, monitoring.

Mediterranean Diet: Cardiorenal benefits; tele-counseling for potassium/phosphorus/sodium adjustments.

DASH Diet: Hypertension-focused with CKD adaptations via telehealth.

Specific Nutrients:
Sodium — label reading, meal prep, restaurant strategies, progressive reduction with monitoring.
Protein — individualized by CKD stage; very low protein with ketoanalogues in select regions; monitor nutrition/kidney function.
Phosphorus — distinguish bioavailability (animal vs plant) + additive awareness with label education.
Potassium — personalized low/high strategies; cooking techniques for leaching when needed.

Stone formers: oxalate reduction, substitution visuals, lemon juice/citrate approaches monitored virtually.

Weight Management: Balanced nutrition + activity; tele-monitoring and accountability; obesity/metabolic syndrome relationship.

Physical Activity Prescriptions: Individualized with demo, monitoring, and progressive advancement.

Sleep Optimization: OSA screening, home testing, CPAP adherence via telehealth.

Smoking Cessation: Structured programs, medications, virtual group sessions + 1:1 support.

Mindfulness, movement (yoga/tai chi), and symptom-focused tools (e.g., acupressure for pruritus) adapted for telehealth delivery.

Complementary counseling: nephrotoxicity risks of certain herbal products (e.g., aristolochic acid); alcohol considerations with transplant/immunosuppression or glomerular diseases.

Mental Health Integration: PHQ-9/GAD-7 screening, referrals, and coordination with behavioral health providers.

Social Determinants: Food, transport, housing, literacy; connect patients to resources virtually.

Structured Education Programs: CKD education (G0420/G0421) and virtual group visits for lifestyle management.

Advanced care planning and palliative care via telehealth, with family participation and cultural tailoring.

Clinic Blueprint: Video consultation environment (lighting/sound/background), reliable connectivity, redundancy, PHI security.

Role Design: Providers, RN/care coordinator, dietitian/social worker as needed; role definitions, workflow assignments, communication protocols.

Core Clinical Workflows (SOPs):
Patient Onboarding — scheduling, consent, identity, tech assessment, baseline data.
Visit Workflows — new vs established; prep, conduct, documentation, follow-up tasks.
Group Education — scheduling, platform, content, participation, billing.
Provider-to-Provider Collaboration — eConsult intake, review, documentation, communication.

RPM: Devices, data monitoring, alerts, response, time documentation (99453, 99454, 99457, 99458).

CCM: Multiple chronic conditions, care plan, regular contacts, coordination, time documentation (99490, 99439, 99487, 99489).

PCM: Single complex condition (CKD), care plans, monitoring (99426-99428).

TCM: Post-discharge support (99495-99496).

RTM: Therapeutic adherence/response monitoring (98975-98977, 98980-98981).

Behavioral Health Integration: Screening, referral, collaborative care models.

Nutrition Counseling: Scheduling, documentation, billing; direct or via renal dietitians.

Laboratory Partnerships: eOrdering, result systems, patient communication; home phlebotomy.

Specialized Settings: Dialysis tele-rounding; transplant co-management; SNFs; hospital e-consults; second opinions; international consultations; employer/payer kidney programs.

Marketing/Acquisition: Digital presence, referral relationships, patient journey, intake automation, CRM integration, no-show reduction.

Quality & Analytics: Clinical measures (BP control, progression rates, vaccinations, monitoring), KPIs (panel size, visit volume, RPM adherence, readmissions), financial analysis (P/L, cash-flow).

Coding & Revenue Cycle: E/M (99202-99215), virtual check-ins (G2012/G2252), e-visits (99421-99423), eConsults (99451/99452), care management (RPM/CCM/PCM/RTM), TCM (99495-99496), ESRD (90960-90966), education (G0420/G0421); fee schedules, payer mix, documentation training, prior auth, denials, OIG self-audits, BAAs, tele-liability coverage, growth planning.

AKI Risk Prediction: ML models for earlier identification and intervention.

Digital Kidney Twins: Patient-specific simulation models for personalized predictions (emerging).

Ambient Documentation: AI transcription/documentation; accuracy verification and privacy.

Secure Data Integrity: Blockchain-like audit trails; multi-provider kidney care coordination.

Wearables: Continuous/incremental BP, HRV, activity, volume status sensors.

Home Imaging: Patient-guided ultrasound for kidney/bladder/access visualization.

Connected Home Diagnostics: Smart toilets/urinalysis with automated frequent assessments.

Point-of-Care Testing: Home creatinine/electrolytes and emerging injury biomarkers (NGAL, KIM-1, TIMP-2*IGFBP7).

Genetic Therapies: CRISPR for PKD/Fabry (emerging); telehealth for selection, monitoring, follow-up.

Novel Pharmaceutics: Beyond SGLT2 for CKD progression; tele-initiation and monitoring.

Microbiome Interventions: Gut-kidney axis; dietary/microbiome manipulation with virtual guidance.

Pharmacogenomics: Genetic tailoring of meds; testing and CDS via telehealth.

Tele-rehab: Exercise for frailty/sarcopenia/cardiovascular deconditioning; remote vital/performance monitoring.

Voice Assistants: Adherence, symptom monitoring, education reinforcement.

Closed-loop Systems: BP readings integrated with supervised med adjustment algorithms.

Enhanced Sensors: Integrated HHD/PD sensor streams for adequacy and problem detection.

AI Alarm Systems: Predict complications; reduce events/hospitalizations.

Automated Adjustments: Closed-loop dialysis based on real-time physiology; telehealth oversight.

Equity-by-design (mitigate algorithmic bias), privacy/data governance, digital phenotyping consent, and environmental sustainability of digital health.

Regulatory future: post-PHE transitions, international collaboration (licensure/liability/payment), SaMD regulation.

Weekly Knowledge Checks: Quizzes on core concepts, regs, clinical knowledge; immediate feedback and remediation.

Skills Checklists: Platform navigation, virtual exam, RPM setup, documentation; self-assessment + instructor validation.

Mock Tele-Visit OSCEs: Standardized patients across nephrology scenarios.

Coding & Documentation Practicals: Applied coding, compliant documentation, billing exercises with case analysis.

Technology Implementation: RPM setup lab, telehealth platform configuration, EHR template design.

Operational Readiness: Compliance drills, marketing asset creation, workflow simulations.

Launch-Ready Playbook: Clinical protocols, workflows, tech specs, compliance docs, and financial projections.

Build-Your-Clinic Sprint: Create website content, consents, SOPs, education resources, marketing materials.

Presentation & Defense: Faculty/peer review; Q&A and scenario adaptability.

Peer & Expert Review: Structured feedback to refine implementation before launch.

90 Days of Mentorship: Post-grad guidance during implementation with regular check-ins.

100% Job Placement Assistance: Resume, interview prep, connections with hiring organizations.

5+ Practice Models Supported: Solo micro-practice, group integration, system employment, platform contracting.

Additional: Portfolio development, interview preparation, contract review workshop, payer enrollment guide.

Certification & CE: Formal TeleNephrology Certification; compliance certificates (HHS, HIPAA, HITECH, OIG, OSHA, ONC); alumni network.

Blood Pressure Monitoring: Devices, education, thresholds, monitoring, interventions.

Volume Status Tracking: Daily weights for CHF, nephrotic syndrome, dialysis; thresholds and intervention protocols.

Glucose Management: CGM or frequent checks for DKD with hypoglycemia vigilance; integrate with meds.

Revenue via 99453/99454 (devices) + 99457/99458 (monitoring); careful device selection, education, alert/documentation workflows.

CKD Education Classes (G0420/G0421): Tele-classes with caregivers for process, options, diet, self-care.

Group Lifestyle Visits: Diet, exercise, stress, adherence with peer support and efficient delivery.

eConsults for Primary Care (99451/99452): Asynchronous nephrology input with templates and billing.

Dialysis Tele-Rounding: Increase presence without travel; ESRD capitated services or facility agreements.

Transplant Virtual Co-Management: Post-transplant follow-up with centers through service agreements or direct billing.

CCM/PCM/TCM: Monthly revenue via structured coordination, time tracking, documented care plans.

Nutrition Counseling: Labels screen-share, virtual meal prep, and planning.

Behavioral Health Integration: Screening to embedded collaborative care; address common mental health conditions.

Implementation Keys: Regulatory compliance, tech integration, staffing models, targeted marketing and referral value propositions.

64F, eGFR 38, BP 142/86, UACR 320 mg/g. Plan: CMP, UACR, lipid panel; RPM for BP; consider finerenone if labs allow; statin optimization; dietary counseling. Tech: video, portal, connected BP. Billing: 99214 + RPM 99453/99454/99457/99458.

72M CKD4, K 5.8 on lisinopril + spironolactone. Tele-triage, med/diet review; initiate patiromer 8.4g daily; reduce spironolactone; keep ACEi; low-K diet; repeat CMP 48-72h; ED precautions. Billing: 99214; follow-up G2252 if 11-20 min discussion.

26M gross hematuria after URI, persistent microscopic hematuria and proteinuria (2+). Orders: protein quant, serologies, renal US, CMP; home BP. Start ACEi; biopsy referral if indicated; shared decision-making. Billing: 99204; plus 99451 eConsult if applicable.

45F, 3 stones/5 years, recent stone CaOx. Plan: 24-hr urine profile; personalized diet; consider thiazide if hypercalciuria; potassium citrate if hypocitraturia; imaging follow-up. Tech: video, e-order 24-hr urine, hydration tracking app. Billing: 99213-99214; consider G0420 for CKD education if applicable.

58M CAPD, exit site redness. Visual exam, photos via portal; start mupirocin; culture via home nurse/lab; exit-site care via video; 48h follow-up; escalation criteria for peritonitis signs. Billing: 99214 or included in ESRD monthly code (90963-90966).

47F DD kidney transplant, creatinine 1.2→1.8. Same-day tele-eval; tacrolimus level, CMP, CBC, UA, culture, renal US, BK PCR, DSA as needed; coordinate with transplant center; adjust tacrolimus if high; daily virtual follow-up. Tech: video, secure messaging. Billing: 99215, document coordination time; G2012 for brief check-ins.

68M CKD3a with PCI and creatinine 1.5→2.2. Tele-follow-up within 48h; med reconciliation; hold ACEi; hydration protocol; BMP twice weekly; warning signs; RPM for BP/weight; portal messaging. Billing: TCM 99495 if criteria met and 99214 as face-to-face.

56F CKD3b, BP 162/94 on amlodipine/lisinopril/chlorthalidone. Tele-eval: med timing/adherence; white coat vs ABPM; screen OSA; add spironolactone 25mg if K ok; RPM; adherence app; secure messaging. Billing: 99214 + RPM codes; consider CCM.

34F UPCR 6.8 g/g, edema. Serologies, SPEP/UPEP, HIV/hepatitis; diuretics with titration; sodium restriction; VTE risk and possible prophylaxis; expedite biopsy; pre/post-biopsy virtual care. Billing: 99215; 99451 for renal pathologist consult if applicable.

78F HCTZ, Na 126 from 138. Same-day tele-eval: med review, fluids, symptoms, weight; stop HCTZ; fluid restriction 1–1.5 L/day; dietary sodium guidance; recheck labs in 24-48h; next-day virtual check-in. Billing: 99214 + G2252 for follow-up if time criteria met.

7:30–8:00 AM: RPM alerts/labs review and documentation.

8:00–9:00 AM: Two new patient consults (CKD 3b and stone prevention) with staged team workflow.

9:00–10:30 AM: Four established tele-visits (post-AKI, stable transplant, monthly home dialysis, resistant hypertension) using templates.

10:30–10:45 AM: Documentation completion with AI scribe verification.

10:45–11:30 AM: eConsult block (hyperkalemia, proteinuria evaluation, contrast prophylaxis) and patient messages.

11:30–12:00 PM: Administrative tasks (OIG mini-audit, weekly HIPAA checks, payer requirements).

12:00–12:30 PM: Lunch + team huddle.

12:30–1:30 PM: CKD education group class for 10 patients (G0420/G0421).

1:30–2:30 PM: RPM coaching calls for 8 patients; physician available for escalations.

2:30–3:30 PM: PD tele-rounds with nurse; adjust prescriptions, assess exit sites.

3:30–4:30 PM: Complex case (RPGN) and transplant coordination call.

4:30–5:00 PM: Practice development (marketing, site updates, CE).

KPIs: 12–16 billable encounters/day across lines; <8% no-show rate; diversified revenue across direct care, RPM, CCM, eConsults.

Clinical Telehealth Skills: Virtual kidney exam, triage, condition protocols.

Technology Integration: Platforms, RPM, documentation, HIE, troubleshooting, workflow optimization.

Regulatory Navigation: Licensure, prescribing, reimbursement, HIPAA, security, billing integrity.

Also communication, coordination, remote team management, telehealth quality.

Standard Operating Procedures, clinical scripts, consent forms, policy library, website content, payer enrollment guide.

Placement Assistance: Resume, interview prep, connections.

Ongoing Mentorship: 90 days support with check-ins.

Alumni Community: Peer support, CE, resource updates.

Revenue Templates & Financial Projections: RPM/CCM/PCM templates, scalable models from micro-practice to health system integration.

Compliance Certification: HHS telehealth policy, HIPAA/HITECH, OIG compliance, OSHA/Health IT/ONC.

Career Pathways: Independent tele-nephrology, hybrid practice, health system roles, platform contracting, academic telehealth leadership.

Base: 200 encounters/month (approx. moderate volume). Reimbursement range: \$95–\$700 per encounter (varies by service and complexity). Figures represent gross revenue before expenses; RPM/CCM/PCM/ancillaries not included in visit-only estimates.

Minimum (200 × \$95): \$19,000/month (\$228,000/year).
Maximum (200 × \$700): \$140,000/month (\$1,680,000/year).

Growth (240 visits):
Minimum \$22,800/mo; Average ~\$95,400/mo (avg \$397.5/visit); Maximum \$168,000/mo.

Service Mix Example: New patient 20%, follow-up 40%, eConsults 15%, group 10%, complex care 15% (illustrative).

Ancillary Revenue: RPM (99453/99454/99457/99458) with 100 enrolled can generate \$10k–\$15k/mo; CCM/PCM add \$5k–\$10k/mo; TCM \$2k–\$3k/mo for 10–15 cases.

Key Success Factors: Accurate coding, necessity documentation, precise time tracking, payer policy alignment, efficient scheduling.

HHS Telehealth (telehealth.hhs.gov), HIPAA (45 CFR Parts 160/164), HITECH, ONC Cures Act Final Rule and information blocking, OIG compliance guidance, OSHA telework safety, ONC Health IT Certification, USCDI, TEFCA.

KDIGO: CKD evaluation/management, BP in CKD, diabetes in CKD, glomerular diseases, transplant, anemia, CKD-MBD.
KDOQI: Vascular access, nutrition, dialysis adequacy, CVD in dialysis.

ASN position statements; NIDDK patient education; 2021 CKD-EPI race-free eGFR resources.

AHRQ reviews, ATA guidelines, regional Telehealth Resource Centers.

CMS Medicare telehealth coverage, RPM/CCM/PCM/RTM/TCM/ESRD/education; commercial payer policy databases; coding references (modifiers, POS codes, documentation).

Security frameworks (risk assessment, encryption, auth), device integration guidelines, interoperability standards (HL7, FHIR).

Telehealth SOP templates, quality measurement frameworks, strategic planning tools and implementation roadmaps.

24 weeks, blended asynchronous + synchronous: micro-modules, knowledge checks, implementation exercises, resource library; live labs, case conferences, practice sprints, office hours.

Weeks 1–4: Foundations (history, evidence, modalities, regulations, basic tech skills).

Weeks 5–12: Clinical applications (conditions, exams, monitoring, virtual protocols).

Weeks 13–20: Advanced implementation (RPM data, coordination, quality, ops, RCM).

Weeks 21–24: Capstone integration and launch planning.

Content: 2–4 micro-modules/week (~4–6 hours).

Skill Practice: Weekly live labs (1–2 hours).

Clinical Application: Case conferences or sprints (1–2 hours).

Assessment: Weekly knowledge checks and skill demos.

Milestones: Week 4 foundations assessment; Week 12 mid-program practical; Week 20 implementation readiness; Week 24 capstone defense.

Online Application: at www.Telehealth.school/apply (credentials, setting, experience, goals).

Eligibility Review: License/certification, good standing, technical capacity.

Consultation Call: Goals, context, track recommendation, Q&A.

Track Selection: Full certification; focused implementation; or academic/leadership—based on setting and experience.

Enrollment Confirmation: Documentation, technology assessment, payment processing (payment plans), enrollment agreement. Orientation begins 7–10 days before start.

Schedule Orientation — timeline, commitments, milestones, time management.
Technology Onboarding — platforms, accounts, simulation tools, support.
Cohort Introduction — community building, collaboration setup.

Standard Program Fee: \$12,500 (Single payment \$12,000; Quarterly \$3,175 × 4; Monthly \$1,095 × 12).

Enhanced Package: \$15,750 (adds 6-month mentorship, marketing package, priority placement, +10 hours consulting).

Financial Assistance:
Scholarships (20–40%) for underserved/need; Group discounts (10% for 2, 15% for 3, 20% for 4+); Financing partners (deferred options up to 36 months).

Included: Full content and 12 months access post-completion, all live sessions + recordings, implementation toolkit, simulation licenses during program, basic career services, 3 months mentorship, alumni community.

Withdrawal/Deferral:
Before orientation: Full refund minus \$250 fee
During orientation: 90% refund
Weeks 1–2: 75% refund
Weeks 3–4: 50% refund
After week 4: No refund (deferral available within 12 months; \$500 deferral fee).

Federal framework, PHE flexibilities vs permanent provisions, evolving policies; state licensing, prescribing, reimbursement; multi-state practice; most restrictive standards across jurisdictions.

Privacy: Patient rights, permitted uses/disclosures, minimum necessary, authorizations, special protections.
Security: Administrative, physical, technical safeguards; BAAs with vendors; audit controls; authentication and transmission security.
Breach Notification: Incident response tailored to telehealth; notification requirements.

HITECH: incentives and enforcement; Cures: information blocking and patient access; TEFCA: nationwide exchange; USCDI: core data elements for interoperability in tele-nephrology.

Compliance program structure (7 elements), risk area identification, self-audit methodology, staff training and tracking.

OSHA, ADA, Section 1557, interpreter integration, documentation of language preference and accommodations.

Integration: Scenario-based learning, implementation tools (privacy notices, risk assessments, breach plans), and ongoing monitoring via compliance calendars and update tracking.

PLADO/Med/DASH via tele-counseling with home environment visibility; mindfulness, progressive relaxation, imagery; adapted yoga/tai chi/qigong; CBT-I for insomnia; breathwork and self-massage instruction; thermal therapy; acupressure for uremic pruritus (evidence modest but can be taught virtually alongside conventional care).

Benefit assessment, nephrotoxicity risks (esp. aristolochic acid), drug interactions (notably immunosuppressants/anticoagulants/antihypertensives), and quality/evidence review in a non-judgmental manner.

Systematic screenings, integrated counseling or collaborative care, virtual peer support; SDoH screening and resource navigation; digital equity strategies; culturally appropriate materials and personalized wellness plans with iterative tele-check-ins.

Break geographic barriers; improve continuity; enable specialist collaboration. Continuous monitoring and digital phenotyping support proactive care; decision support and quality measurement improve outcomes. Patient activation, convenience, support integration, and contextual understanding via virtual visits reshape experience.

Hybrid models (appropriate in-person/virtual balance), specialized virtual centers, platform-based roles, collaborative networks, and international consultation. Regulatory evolution, digital equity, and telehealth-specific quality assurance require ongoing attention. Graduates lead with innovation, quality, and patient-centered design to a data-driven, equitable virtual future.