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Melissa Outlaw

By: Melissa Outlaw on February 19th, 2016

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Part 1: Tips and Traps for Telemedicine Credentialing

Healthcare Provider Credentialing

Have you checked out symplr’s education series webcast? In our latest installment we welcome back Rick Curtis as our speaker of the month.

Rick Curtis is the current CEO of The Center for Improvement in Health Quality (CIHQ) and is leading authority on Centers for Medicare & Medicaid Services (CMS) Certification and Survey Process and the Medicare Conditions of Participation (CoP). In this interview, he discusses some tips and traps concerning CMS requirements for telemedicine services.

We’ve organized Rick’s conversation into a two-part blog series covering major points around regulatory focus areas and rules on granting privileges for telemedicine services.

Prior to the 2011 requirement changes enforced by the CMS, telemedicine followed an unnecessarily slow and lengthy process. Technological advances in telecommunications and a shortage of medical specialists has resulted in telemedicine becoming a growing way to offer medicinal solutions in remote areas. So understanding the CMS requirements is increasingly important!

Is Your Service Considered Telemedicine?

To best understand how the credentialing rules apply to telemedicine, you must first understand what telemedicine is and what it’s not.

Telemedicine is the provision of clinical services to patients by physicians and practitioners from a distance via electronic communications. For services to be considered telemedicine, diagnostic or treatment processes must travel a distance away from their originating hospital.

Telemedicine is not a hospital accessing medical information from another hospital. Understanding this nuance will help hospitals understand what is to be surveyed as telemedicine and what is simply taking advantage of technologies within your hospital.

Also, from a CMS compliance standpoint, whether or not a telemedicine service is simultaneous or non-simultaneous is irrelevant. If information is traveling a distance, it must meet CMS compliance requirements.

Written Agreement Requirements

CMS now requires hospitals receiving telemedicine services from a distant Medicare credentialed hospital or a distant site entity to have a written agreement containing CFR 482.12(a)1 through (a)7. This way credentialing and policies in the relationship are consistent with the Medicare CoP.

So, you might ask, what is the difference between distant hospitals and distant site entities?

A Medicare certified hospital must have a written agreement stating that it is the responsibility of the governing body of the distant hospital to satisfy the requirements of CFR 482.12(a)1 through (a)7. The requirements apply only to the physicians and practitioners of the Medicare certified hospital who is providing the telemedicine services. For a distant hospital, the contents of section CFR 482.12(a)1 through (a)7 requires that physicians and practitioners be on the medical staff.

A distant site entity is defined as an entity that provides telemedicine services and is not a Medicare participating hospital. In a distant-site entity, the individual distant-site physician or practitioner must have a license issued or recognized by the State in which the hospital receiving telemedicine services is located. Also, written agreements for telemedicine services provided by a distant site entity are treated as contracts – meaning all accountable parties involved need to be represented in the written agreement.

Avoid Traps: Holding All Parties Accountable

CMS certification requires that all accountable parties be represented in the written agreement, including subcontractors who are performing work on behalf of a contractor.

While subcontracting is a common business practice for critical operations, the hospital receiving the telemedicine services needs to make sure that the relationship is stated in the written agreement. Failing to represent subcontractors in the written agreement may place you in a trap, leading to a violation.

To protect yourself from a violation, the written agreement needs to be changed following one of two options:

  1. Amend the written agreement to include the subcontractor
  2. Extend the scope of the contract to include the subcontractor with the contractor as a proxy

This ensures that all parties involved are obligated to meet the Medicare CoP requirements, keeping the relationship CMS certified.

Was this helpful? Then stay tuned for the second part of our series! Next up, we will discuss more privileges and understanding the CMS requirements in more depth.

For more tips on written agreements and insight on avoiding traps, listen to our symplr education series webcast titled Telemedicine: Tips and Traps!

To learn more about effective and user-friendly credentialing solutions, Schedule a Demo with symplr now!


About Melissa Outlaw

Melissa Outlaw is a Vice President, Customer Success with symplr. Melissa and her team assist clients in learning and implementing our provider management software - credentialing, privileging, peer review, quality and event reporting applications. She supports clients in benchmarking current internal practices, identifying potential efficiencies, then driving the integration of technology with process improvement to reduce time of service and operating expenses. She works extensively with decentralized, multi-facility organizations in transitioning to a shared service center as well as assisting healthcare organizations bridge the gap between procedures performed by a provider and their privileges granted.