How to Navigate Telemedicine and Medical Credentialing

Telemedicine is a rapidly expanding field that has accelerated during the COVID-19 pandemic. Proponents argue that telemedicine significantly increases healthcare access for patients in rural areas, seniors on Medicare (1 in 5 who live outside of a major metropolitan area), socioeconomically vulnerable populations in major urban areas, and the next “on-demand” generation. COVID-19 has brought a different level of severity to the equation.

As telemedicine rapidly expands, policies are changing to meet those new demands. In order to meet new norms, telemedicine providers must stay up to date on quickly-shifting expedited processes, virtual physician credentialing, and other regulations regarding telemedicine updates.

Updates on Telemedicine Regulations

Telemedicine has a long history starting with the NASA space race to be able to monitor astronauts’ health. We’ve come a long way since then. With rapidly expanding technological capabilities such as live feeds and reduced cost of technology, modern telemedicine startups in 2014 quickly became a norm. Major insurance providers like Aetna, Anthem, and UnitedHealthcare began coverage in 2016, and COVID-19 has prompted even more attention to telemedicine expansion.

With technology and insurance outpacing regulations, state boards are implementing telemedicine-related standards that vary from state to state. To deliver care at the same standards as in-person care, the Federation of State Medical Boards (FSMB) and the American Medical Association (AMA) issued a document outlining state-by-state regulatory and administrative requirements for telemedicine.

These regulations include (but are not limited to):

• Cross-state licensing
• Online prescribing
• Reimbursement
• Physician-patient relationship
• Informed consent

Credentialing Telemedicine Providers – Possible Risks

Telemedicine creates opportunities for more streamlined credentialing and privileging. HHS waived requirements, due to the current Public Health Emergency, for physicians or other health care professionals to hold licenses in the state in which they provide services with respect to Medicare and Medicaid services. Therefore, privileging is only required to come from originating site hospitals. This significantly speeds up the telemedicine credentialing process and reduces administrative overhead.

However, without the in-depth processes required by privileging, healthcare organizations risk malpractice and negligent credentialing lawsuits. In order to provide the same trust and standard of care for telemedicine providers, healthcare organizations must go through a rigorous and regularly updated pre-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 with top industry-trusted tools.

The best tools provide automation and continually screen for regulatory updates so that your organization isn’t overburdened trying to stay current with all the changes in credentialing requirements. By integrating real-time tools, you can ensure that providers’ credentials such as education, training, board certifications, licenses, and work history are correct and verified.

Telemedicine and COVID-19

In March of 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act became law, loosening existing telehealth restrictions. Soon afterward, the Centers for Medicare and Medicaid Services (CMS) expanded the waiver for telehealth. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) provided additional funding and flexibility for telehealth provisions. Broadening access to Medicare telehealth services, beneficiaries can now receive a wider range of services from their telehealth providers.

In addition to the HHS waiver of geographical site restrictions for physicians and streamlined credentialing, there have also been some significant regulation changes that expedite the process of making telemedicine a standard of care.

Some of the changes in light of COVID-19 include: 

• Originating Site: Previously only certain individuals considered to live in extremely remote areas could receive telehealth services under Medicaid and Medicare. The secretary has waived “originating site” and geographical site restrictions to allow patients to receive services in their homes wherever they are.
• Device Type: The restrictions on types of devices used for telehealth services have also been loosened so that personal phones and tablets may be used by patients, provided that the devices have both audio and visual feeds. Practitioners are also allowed to use communication technology such as FaceTime or Skype during COVID-19 without breaking HIPAA rules.
• Patient and Service Eligibility: Previously only existing patients (of 3 years or more) could utilize a wide variety of telemedicine services. Under COVID-19 telemedicine, both new and existing patients may now use telemedicine for a wide variety of services. While still requiring informed consent, this exponentially increases the number of patients who can take advantage of telemedicine.

In addition to these regulatory changes, CMS also announced a number of new flexibilities for providers and services around billing and coding telemedicine in light of COVID-19. The CMS fact sheet provides clarification around these new waivers during the national emergency period.

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 has lifted these barriers, the age-old idiom that “you can’t put the genie back in the bottle” is likely true for a post-pandemic healthcare landscape. 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 rise to meet those needs with automation, cutting-edge technologies, thorough provider screening against multiple exclusion lists, and increased transparency.

Is your healthcare organization prepared to meet the next generation of shifting demands in virtual physician credentialing? If your organization would like to learn more about real-time telemedicine provider screening, reach out to Verisys for the gold-standard in verification and credentialing software.

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