Healthcare: New Regulations Ease the Credentialing Requirements for Telemedicine in Medicare Facilities

06.01.11

New CMS regulations issued May 5 allow Medicare participating hospitals and critical access hospitals ("CAHs") to provide telemedicine services with reduced administrative burden. The new regulations provide an alternative, abbreviated means of credentialing the physicians and practitioners who provide medical services from a distance via electronic communication. CMS will now permit a hospital or CAH to rely on the credentialing by the telemedicine physician's "home-base" hospital as the basis for its own credentialing of the physician. In announcing the new regulations, CMS stated that it instituted the change to bring "more flexibility to small hospitals and CAHs in rural areas and regions with limited supply of primary care and specialized providers."

Fundamentally, Medicare-participating hospitals and CAHs must credential and grant appropriate privileges for all physicians and practitioners who provide medical services to its patients. This applies not only to the facility's "local" medical staff, but also to the providers who furnish care to the facility's patients from a distance by telemedicine. Until the arrival of this new regulation, even a small or rural hospital's medical staff and governing body had to thoroughly examine, verify and approve the credentials of all its telemedicine providers in the same fashion that it vetted its "local" medical staff members. Similarly, this required a CAH to enter an agreement with an qualified outside institution to perform the same full-blown process for it. In both cases, this onerous requirement was seen to impede the use of telemedicine to bring essential medical services to patients. That system, CMS stated, was "duplicative and burdensome ... [for] small hospitals and CAHs, which often lack adequate resources to fully carry out the traditional credentialing and privileging process for all the physicians and practitioners that may be available to provide telemedicine services."

Therefore, CMS designed the new regulations to allow a more convenient means of credentialing telemedicine providers. The new regulation provides that, if the telemedicine physician's or practitioner's credentials are approved by his home-base hospital (the "remote" hospital), it is no longer necessary for the hospital at which the patient receives the telemedicine services (the "local" hospital) to duplicate every step of the credentialing process. If the remote hospital's credentialing standards comport with Medicare's credentialing requirements, the local hospital may rely upon the remote hospital's credentialing as the basis on which to approve the physicians and practitioners who provide the telemedicine services. The new telemedicine credentialing and privileging regulations for CAHs are modeled after the hospital requirements with almost no differences.

In order for hospitals to employ the new credentialing method, the following specific requirements must be met: (1) the remote hospital and the local hospital must enter a written agreement for the provision of telemedicine services; (2) the agreement between the hospitals must provide that the remote hospital will apply Medicare's credentialing standards to the physician or practitioner who provides the telemedicine services; (3) the remote physician or practitioner must be credentialed and privileged at the remote hospital and the remote hospital must provide the local hospital with a current list of the physician's or practitioner's privileges; (4) the physician or practitioner who provides the telemedicine services must be licensed to practice in the state in which the patient receiving telemedicine services is located; and (5) once a physician or practitioner is credentialed to provide telemedicine services at th e local hospital, the local hospital must inform the remote hospital of all information about the physician or practitioner that the remote hospital will need in performing its own periodic credentialing review, including any adverse events resulting from the telemedicine services.

The new regulations specifically amend the Medicare conditions for participation for a hospital's governing body and its medical staff (42 CFR §§482.12 and 482.22) and the conditions for participation for critical access hospitals (42 CFR §§485.616 and 485.641).

The author, David J. Hyman, may be contacted at dhyman@dsda.com.

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