Credentialing for Telemedicine Providers

December 11, 2021by Sherana Tucker

Credentialing for Telemedicine Providers

Telemedicine is a rapidly expanding field that has only accelerated even further during the COVID-19 pandemic. It has been widely accepted that telemedicine can significantly increase access to care for seniors on Medicare, the socioeconomically vulnerable, patients in rural areas, and what is deemed the new “on-demand” digital generation. COVID-19 has brought a different level of need to the telemedicine equation.

As telemedicine continues to rapidly expand, it is only natural for licensing and credentialing policies to shift and change to meet those new demands. Hospitals and telemedicine providers must stay up to date on virtual physician credentialing, quickly-shifting processes, and new regulations regarding telemedicine updates.

Hospital Credentialing for Telemedicine Providers

Telehealth providers may not maintain a physical presence in the hospital where they provide care, but they are still required by law to undergo updated credentialing. The telehealth industry has been rapidly expanding since the beginning of the COVID-19 pandemic, and CMS has expanded payment for telehealth services and credentialing as well, known as “credentialing by proxy.”
Credentialing by proxy permits the hospital or “originating site” to receive telemedicine services via relying on the privileging and credentialing decisions made by the entity that provides the telemedicine services or “distant site” hospital.

By streamlining this process, hospital administrators can avoid the burden typically associated with the traditional credentialing process. It can also reduce the redundant complexities of credentialing at multiple facilities by allowing medical providers to perform telemedicine services and treat patients in more locations in order to get the services they need.

So what is the catch? Although this new process can allow hospitals and telemedicine providers to deliver services faster (and at a lower overhead), without the proper credentialing tools in place, it could also expose hospitals to risk. Therefore, it’s critical to have continuous monitoring and review of all provider credentials in order to detect suspicious and costly activity.

Credentialing Across State Lines

It may seem easier not to have to entertain patients in a traditional office, but telemedicine invites its own set of difficulties. The work it takes to license and credential a provider (and maintain those credentials) will double for every state where the provider holds a medical license (up to 50), and for every hospital affiliation, they require.

Currently, many telemedicine providers work across state lines, where licensure requirements frequently differ. Add to this a slew of conflicting regulations for telemedicine malpractice cases, and you’ll quickly find yourself wishing you had a credentialing expert to help you keep up with the madness.

With the onset of the Coronavirus, state officials took a number of emergency actions to ease the rules on telehealth, such as allowing out-of-state providers to treat residents and in-state providers to treat those in other states.

According to the Federation of State Medical Boards, roughly 24 states enacted emergency rules aimed at relaxing telehealth licensing and credentialing requirements. But, just as before, each state’s rules are different, and providers have to do a considerable amount of research before virtually venturing across state lines to practice telemedicine.

To further complicate things, the language used when issuing emergency declarations vary and can be confusing. Several states give out-of-state providers the ability to “practice in” the state or “render temporary assistance” without clarifying whether practicing medicine includes using telemedicine technology.

Current Challenges of Telemedicine Credentialing and Privileging

Without established in-depth processes for credentialing and privileging, healthcare organizations are at risk for malpractice and negligent credentialing lawsuits. To continue to provide patients with the same trust and standard of care via telemedicine, healthcare organizations and providers must go through a rigorous and regularly updated screening process.

In order to prevent negligent credentialing lawsuits, be sure to regularly and thoroughly update your documentation and credentialing processes, conduct regular background checks, implement an ongoing monitoring process, and implement thorough pre-approval screenings and top industry-trusted credentialing specialists.

By partnering with a credentialing specialist, you can protect your organization while ensuring that providers’ credentials such as education, training, board certifications, licenses, and work history are correct and verified.

This will ensure that you or your providers aren’t overburdened with current telemedicine changes so you can do what you do best, focus on your patients.

Looking Ahead: What Does the Future Hold for Telemedicine?

What will telemedicine look like in a post-COVID-19 world? We can’t be sure, but we do know that previous obstacles such as payer reimbursements and the associated expenses have proven to not be the obstacles we once thought they were.

Now that the public health emergency situation is lifting these barriers, the post-pandemic healthcare landscape has shifted. With streamlined processes to meet technology updates, telemedicine is here to stay.

With these changes come increased challenges for credentialing, security, and patient safety. We can help you rise to meet those needs with our thorough provider screening and file management services.

Is your healthcare organization prepared to meet the next generation of shifting demands in virtual physician credentialing? If you or your organization would like to learn more about our telemedicine credentialing services for providers, reach out to the CredentialPro team for the gold-standard in verification and customer care.

Sherana Tucker
655H Fairview Rd, Ste 301 Simpsonville, SC 29680

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