CMS Proposes Streamlined Approach for Credentialing of Telemedicine Providers

Summer Issue 2010Newsletters Staying Well Within the Law

On May 26, 2010, the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule that would ease the burden for Medicare-participating hospitals and critical access hospitals (CAHs) when it comes to credentialing and privileging off-site telemedicine providers. The proposed rule would revise the existing Medicare conditions of participation (CoPs) for both hospitals and CAHs to allow for a new streamlined credentialing and privileging process for physicians and practitioners providing telemedicine services.

The current CoPs require Medicare-participating hospitals and CAHs to credential and privilege each physician and practitioner providing telemedicine services from a distant site as if such physician/practitioner were onsite. While hospitals and CAHs are permitted to use third-party credentialing verification organizations, the ultimate responsibility for privileging decisions remains with the facility's governing body.

In the past, hospitals accredited by The Joint Commission (TJC) were deemed to meet the Medicare CoPs under TJC's statutory deeming authority. TJC's medical staff standards permit privileging by proxy whereby a TJC-accredited originating site (i.e., the site where the patient is located) may accept the credentialing and privileging decisions of a TJC-accredited distant site (i.e., the site where the practitioner providing the telemedicine service is located). Pursuant to Section 125 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275, July 15, 2008), the statutory recognition of TJC's hospital accreditation program was terminated effective July 15, 2010. As a result, TJC-accredited hospitals that have used privileging by proxy to credential and privilege their telemedicine providers up to this point may no longer do so.

CMS recognized in the proposed rule the significant burden that would be placed on existing telemedicine programs, particularly those of small or rural hospitals and CAHs that are TJC accredited, if privileging by proxy is no longer permitted. Such institutions often lack the resources to carry out the traditional credentialing and privileging process for the physicians and practitioners who provide telemedicine services and rely on the larger academic medical centers that provide such practitioners to fulfill that function.

The proposed revisions affect two Medicare hospital CoPs – 42 C.F.R. § 482.12 "Governing Body" and 42 C.F.R. § 482.22 "Medical Staff." Under the proposed rule, CMS would add new paragraph § 482.12(a)(8) that would allow a hospital's governing body to grant telemedicine privileges based on its medical staff recommendations, which in turn would rely on information provided by the distant-site hospital. Under this new provision, the agreement between the hospital and the distant site must specify it is the responsibility of the governing body of the distant site to meet the requirements of paragraphs (a)(1) through (a)(7) of § 482.12 with regard to its physicians and practitioners providing telemedicine services.

The proposed rule would also add § 482.22(a)(3), which grants a hospital receiving telemedicine services the option to rely on the credentialing and privileging decisions of the distant site in lieu of the current requirements at §§ 482.22(a)(1) and (a)(2), which require the hospital's medical staff to conduct individual appraisals and examine the credentials of each candidate in order to make a privileging recommendation to the governing body. In order to avail itself of this option, the hospital receiving the telemedicine services must ensure that:

  1. The distant site hospital is a Medicare-participating hospital.
  2. The individual distant-site physician or practitioner is privileged at the distant-site hospital providing the telemedicine services, which provides a current list of the distant-site physician's or practitioner's privileges.
  3. The individual distant-site physician or practitioner holds a license issued or recognized by the state in which the hospital, whose patients are receiving the telemedicine services, is located.
  4. With respect to a distant-site physician or practitioner granted privileges, the hospital whose patients are receiving the telemedicine services has evidence of an internal review of the distant-site physician's or practitioner's performance of these privileges and sends the distant-site hospital such performance information for use in the periodic appraisal of the distant-site physician or practitioner. At a minimum, this information must include all adverse events that result from the telemedicine services provided by the distant-site physician or practitioner to the hospital's patients and all complaints the hospital has received about the distant-site physician or practitioner.

The proposed telemedicine privileging and credentialing requirements for CAHs are virtually the same with almost no differences in the regulatory language.

CMS will accept comments on the proposed rule until July 26, 2010.

For more information about this topic, please contact Victoria Heller Johnson at 610.458.4980 or [email protected].