Privileging to Expand Telemedicine

Telemedicine has transformative implications on the traditional healthcare model.

But these implications, including reduced costs and increased care access, have been complicated by regulations. Until recently, state and federal regulations related to licensing, credentialing, and privileging for telemedicine providers created barriers to telemedicine adoption. In the past, Centers for Medicare and Medicaid Services (CMS) limited the use of telemedicine to patients in healthcare facilities in rural areas, where fewer providers are available. Furthermore, some states had adopted clinical practice rules with stricter standards for telehealth than for in-person care.

COVID-19 has created a need for remote treatment options that reduce the risk of cross-contamination and exposure associated with close contact. Telemedicine allows mildly ill patients to receive treatment while minimizing their exposure—and that of healthcare providers—to other acute illnesses. Recent policy changes during the COVID-19 pandemic have reduced barriers to telehealth access to meet the demand for providers. Telehealth visits increased 300-fold from March 15 to April 14, 2020, compared to the same timeframe in 2019. To increase access to care during the COVID-19 national emergency, the government has relaxed restrictive regulations for telemedicine utilization, including patient eligibility, reimbursement, interstate licensing, and privileging.

Telehealth Regulations Temporarily Relaxed

Patient eligibility. The Coronavirus Preparedness and Response Supplemental Appropriations Act gives CMS the authority to waive or modify Medicare requirements related to telehealth services, originating site, and geographic requirements. Medicare beneficiaries in all areas of the country—not just rural areas—can receive telehealth services, including at their home via their smartphone, during the emergency.

Reimbursement. Historically, telemedicine has been subject to different reimbursement schedules. Only 20 percent of states require payment parity between telemedicine and in-person services. CMS and some local commercial payers have modified their payment policy in response to COVID-19. Medicare can now pay for office, hospital, and other visits furnished via telehealth, regardless of geography (i.e., including non-rural areas). Visits delivered by telehealth are considered office visits and are reimbursed at the same rate as traditional in-person visits. 

Licensing requirements. State laws and regulations require providers to be licensed in the same state as the patient, even if they are already licensed in their own state. Depending on state requirements, providers may be required to take additional online or in-person training to be licensed in that state. State licensing can take up to four months. CMS has temporarily waived requirements that out-of-state practitioners be licensed in the state where they are providing services, for providers who are 1) enrolled in the Medicare program; 2) licensed in the state that relates to their Medicare enrollment; 3) providing in-person or telehealth services in a state where the COVID-19 emergency is occurring, to contribute to relief effects; and 4) not excluded from practicing in that state or any state that is part of the emergency area.

Credentialing and Privileging. To deliver telemedicine services throughout your healthcare organization, providers must be privileged at each hospital. Different hospitals may have unique credentialing and/or privileging requirements. Now, according to The Joint Commission, providers who are currently credentialed and privileged in your facility can furnish the same patient care services via a telehealth link, without any additional credentialing or privileging specifically for telemedicine. You do not need to specify telehealth as a privilege for those providers.

Accelerating Privileging to Expand Telemedicine Services

Provider privileging can take up to 60 to 90 days, assuming no delays in verifying credentials, when the process isn’t streamlined. When you desperately need providers during a national emergency, you can’t afford to wait that long. Under Emergency Protocol, you may grant providers disaster or emergency privileges—temporary privileges that will be terminated once the situation is under control. In this situation, the privileging process can be completed in 72 hours.

RELATED BLOG: COVID-19 and Telehealth: Accelerating the Virtualization of Healthcare

Whether you are granting disaster or full privileges, you need fast, accurate, compliant privileging processes. An automated provider privileging solution that is integrated with contracting, credentialing, and enrollment solutions streamlines and accelerates provider onboarding and increases provider satisfaction.

TractManager’s Provider Privileging solution can help you quickly privilege new telemedicine providers as well as your current providers who lack privileges at some of your hospitals. Our provider privileging software speeds up the process with easy access to real-time provider data stored in a single, central database. TractManager’s modernized privileging technology integrates with over 250 sources of primary information and provider data, eliminating manual processes.

For more information on accelerating your provider onboarding processes, download The 4 Ds of Provider Onboarding Guide.

References:

Telemedicine Credentialing, Licensing and Privileging: A Primer

Expansion of Telehealth During COVID-19 Pandemic

50-State Survey of Telehealth Commercial Payer Statutes

Virtually Perfect? Telemedicine for Covid-19

COVID-19 HHS and FCC Telehealth Changes

Credentialing & Privileging: COVID-19’s Impact

Author:

Anna Arutyunyan

Vice President, CVO, Provider Management

Anna has extensive experience in the development and implementation of full-scope credentialing programs.

 

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