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In May 2011, the Centers for Medicare and Medicaid (CMS) released its final rule making changes to Medicare Conditions of Participation (CoP) for hospitals and critical access hospitals (CAH) to create a new process for the credentialing and privileging of telemedicine practitioners. CMS’s intent in implementing these changes is to remove the hardship and financial burden imposed on hospitals and CAHs by current telemedicine credentialing and privileging requirements. The final rule became effective on July 5, 2011.
Previously, the CoP required a hospital or CAH to thoroughly examine and verify credentialing information and make independent decisions to privilege practitioners providing telemedicine services, as if the telemedicine practitioner practiced on-site. These requirements conflicted with The Joint Commission (JC) standards, which permitted a form of “privileging by proxy,” allowing hospitals to grant telemedicine privileges in reliance on credentialing information from the distant site hospital. Because “privileging by proxy” was not permitted by the Medicare CoPs, JC changed its standards governing privileging of telemedicine practitioners to require a hospital or CAH who uses JC for “deemed status” to make independent privileging decisions but to allow the Medicare participating hospital that otherwise privileged the telemedicine practitioner to serve as a Credentialing Verification Organization (CVO) for the hospitals or CAHs that obtained the telemedicine services. Under the new COPs, subject to certain safeguards, a hospital or CAH now may grant telemedicine privileges, by relying on the credentialing and privileging information of the distant site Medicare-participating hospital. In addition, the CoPs allow the originating site hospital or CAH to grant telemedicine privileges based on credentialing information from a distant site telemedicine entity that is not a Medicare participating hospital, such as a teleradiology entity, referred to as “distant site telemedicine entities” or “DSTEs”.
What Does This Mean?
To use this new “proxy” credentialing and privileging process for telemedicine practitioners, certain requirements must be met. The originating site hospital or CAH (i.e. the hospital or CAH that is obtaining the telemedicine services) must have a written agreement with the distant site hospital or DSTE. If the distant-entity is a Medicare-participating hospital, the governing body of the originating site hospital or CAH must ensure the agreement specifies that it is the distant site hospital’s responsibility to comply with current CMS credentialing and privileging requirements. If the distant site entity is a DSTE, the governing body of the originating site hospital or CAH must ensure the agreement requires the DSTE to furnish the credentialing services, in a manner that enables the originating hospital or CAH to comply with all applicable CoPs and standards.
What You Need To Do Now
Hospitals and CAHs should consider whether they want to take advantage of the new CoP for credentialing telemedicine practitioners. If so, the hospital or CAH should review and, if necessary, update its medical staff bylaws. Form agreements should be developed that incorporate the specific CoP requirements for distant site Medicare-participating hospitals and DSTEs, respectively, and include other beneficial provisions (e.g., protections for patient health information). State law peer review confidentiality standards should be evaluated against the CoP requirement for disclosure of complaints and adverse events concerning the telemedicine practitioner. Until JC updates its standards, hospitals and CAHs that use JC-accreditation for deemed status should wait to fully implement the CoP proxy privileging process.
To read more about the Final Rule, click here.
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