CMS’ TeleMed Rule Eases Physician Credentialing

A new rule from the Centers for Medicare & Medicaid Services is expected to make it easier for small and critical access hospitals to use telemedicine to link with physicians and other larger hospitals or academic medical centers. The change will also make it easier for small hospitals in underserved areas to access specialty services such as teleradiology, teleICU, and telestroke.

The final rule revises the conditions of participation for hospitals and CAHs by implementing a new credentialing and privileging process for physicians and practitioners who provide telemedicine services.

Each hospital and CAH will no longer be required to credential and grant privileges to each physician and practitioner who provides telemedicine services to its patients from a distant hospital or other telemedicine location. Instead, hospitals can rely on the credentialing and privileging decisions of the distant hospital.

For small hospitals and CAHs in rural areas and regions where there may be a limited supply of primary care and specialist physicians, telemedicine can provide more flexible and cost-effective medical care.

Groups such as the American Telemedicine Association, the American Medical Association, and the American Hospital Association have been lobbying for years for the change. Among the complaints: The old system were particularly burdensome for small hospitals, which often lack the staff and the financial resources to confirm the privileges of individual telehealth physicians.

Under the current system, rural hospitals often contract for specific telemedicine services and physician groups. The new rule will mean rural hospitals will have access to a larger pool of physicians and services, explained Mona Moore, director of operations at the Georgia Partnership for Telehealth in Waycross. "This rule allows facility-to-facility credentialing. If a hospital in Waycross has a telehealth contract with a medical center in Atlanta then all of those physicians are automatically credentialed for the Waycross hospital."

Moore said the current system of individual credentialing has meant that rural hospitals must duplicate the credentialing checks already performed by the larger hospitals. The process begins by checking with the national practitioner data bank at the Department of Health and Human Services. If everything checks out, the final credentialing approval is granted by the hospital governing board. The process can take 30 to 45 days because many rural hospital boards often meet only once a month. It also must be repeated annually for each physician to update information about malpractice insurance.

Under the new rule the entire process will be the responsibility of the larger hospital. Additional costs will be negligible because the distant hospital is already credentialing all of its physicians.

The new rule, published on Thursday in the Federal Register, will take effect July 2.