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Credentialing a TeleHealth Company –

Credentialing can be a very intimidating phrase if you aren’t familiar with it, or just getting started and you don’t know where to begin.  So, let’s dive into it to help make this process a little less stressful.

What is Credentialing?

credentialing | Credentialing a TeleHealth Company | STATMedCare Payor and Physician Enrollment and Credentialing

Credentialing is a process of objectively evaluating and verifying a practitioner’s current licensure, training, experience, competence, and ability to provide particular services or perform particular procedures. It is usually carried out by the organization that will bill for the provider’s services.

Do Providers need to be credentialed?

This is a very broad question because it varies from state to state, by education and by specialty.  The requirements for credentialing depends on the requirements of the facility where the patient is located and/or the source of payment for the service. The facility’s medical board may require credentialing to protect the health and safety of their patients, regardless of any other requirements.

The Joint Commission has requirements for physician credentialing in facilities that seek its accreditation. Similarly, CMS has requirements on credentialing that determine whether or not Medicare will pay for telemedicine services. If you are setting up a telemedicine consultation service in a facility that does require credentialing, consult the legal and credentialing teams to establish the requirements for telemedicine.

Unfortunately, the credentialing requirements promulgated by the Joint Commission and CMS do not have the same requirements. Since this affects both facility accreditation and payment, this is an issue that is under active discussion. For more information consult the link below.

Center for Telehealth and E-Health Law

Just a reminder, the credentialing requirements for the Joint Commission and CMS have different standards, and requirements.  There has been confusion of people thinking it is one of the same and they are very different.  

Does the telemedicine provider have to be credentialed at the facility where they are located?

It doesn’t necessarily depend on the location of your facility, but more the scope of services you provide and the type of facility.  If you plan to implement telemedicine consultation services in your practice, more than likely you’ll need to be credentialed.

Do the telemedicine provider have to be credentialed at the facility where the patient is located?

The safest and best answer to this question is “Yes” under current CMS guidelines. There are circumstances though where it could play different. This exception occurs when a physician is providing advice to another physician in a remote facility via telemedicine and the remote physician retains responsibility for the care of the patient. Under these circumstances, consulting specialists do not need to be credentialed at a remote facility so long as they are credentialed at their own institutions, which must be Joint Commission accredited institutions.  However, when it comes to Medicaid patients though, that varies from state-to-state.  Many facilities find it necessary to be credentialed at a remote site because of the Medicare requirements and state requirements.

It is probably best to determine what is required of providers who practice on site and then confirm if credentialing is required for telemedicine consultation providers.  

How do I get my providers credentialed at a remote site that requires it?

If you are needing credentialing for a remote site, then you should have a process already in place.  This process normally requires a set of forms that must be completed and returned to the sites credentialing office.  Noted, what is required though is going to vary from site-to-site so make sure that you contact the credentialing office of the facility that you’re interested in so that you have the proper documents, and understand all requirements.

Also, be aware that you might have to do duplicate work from when you were credentialed for your on-site.  This process takes a considerable amount of paperwork to get this completed.  Also, another thing to be cautious about is that this is a timely process that you are completing.  So it is important not to stress out, and take it one day at a time or better yet, hire a professional credentialing company to handle these matters for you.  

Do the physicians, nurses, and other providers of telemedicine consultations have to be licensed in the state where the remote facility is located?

According Telehealth resource center the answer is “Yes” most of the time. Any practitioner that is required to have a license issued by a state must, in most circumstances, be licensed to practice in the state where the patient is located. The physical location of the provider at the time of the interaction is not a consideration – they can be anywhere. Consultation exceptions may permit physician to physician interactions without a local license in some circumstances. The Federation of State Medical Boards has also promoted the adoption of a special purpose license to cover Telehealth interactions.  For more information on telemedicine licensure issues, consult the Center for Telehealth and E-Health Law website.

For more information on Telehealth Credentialing, Telehealth operations, reimbursement and much more go to:  https://www.telehealthresourcecenter.org.  

If your practice needs assistance with credentialing, licensing or provider enrollment, please contact our office.  

Since 2003, STAT MedCare Solutions has been an expert in Provider Enrollment, Licensing, Rate Negotiation, and other Credentialing-related services.  STAT’s mission is, “Providing Client Services on a foundation of Trust and Integrity.”  We stay on top of teaching, training, and equipping to properly manage the workplace as an industry expert.  STAT has submitted/renewed 250,000+ licenses, submitted more than 10,000 appeals, and renegotiated more than 3,000 contracts. STAT services practices and organizations who are start-ups, surviving, experiencing (rapid) growth,  or maturing Enterprise clients. Contact our Sales team for a free consultation at 877-887-1784, Ext. 505

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Have a Good Day from everyone at STAT!

 

source: https://www.telehealthresourcecenter.org/