- September 29, 2017
- Credentialing
The How-to Guide: Credentialing Telemedicine Providers
In June, we explored the growing telehealth industry and how to prepare your hospital or clinic for telemedicine providers. This time, we`re sailing into (relatively) uncharted territory – the process of credentialing for telemedicine.
Credentialing usually strikes fear into the heart of any hospital administrator, so it`s no surprise that telehealth credentialing seems even less accessible. Because telemedicine is quite new to the healthcare world, the rules about how to credential for it are still being developed as we speak. Let`s take a deeper look at how this will affect you, and [blah blah preparation and being informed about stuff].
Credentialing Across State Lines
Normally, the first step for a provider is to get a license in the state where they want to practice. For a telehealth provider, though, several states require that the provider also get a license in any state where their patients might be located, too. If your providers plan to treat patients in Louisiana or Oregon, for instance, they`ll need to apply for a special telemedicine license first. (1) Luckily, a group of 22 states have begun implementing or are already part of the Interstate Medical Licensure Compact, an agreement that allows qualified providers to practice across states that belong to the compact. (2) The FTC has also gotten involved in legal discussions on the topic, and has become a vocal supporter of Senate bills that promote easier telehealth licensure. (3) Whichever way you go, don`t let those licenses expire on you; use a license monitoring service to stay on top of expiration dates and help your providers avoid late fees or practice gaps.
But as you know, getting established as a telemedicine provider doesn`t stop at licensure. Privileging at out-of-state facilities can be tricky and requires a healthy amount of research before you commit to any process. The Joint Commission used to publish standards to privilege by proxy, which led to a regulations scuffle between the TJC and the Centers for Medicare & Medicaid Services. In 2011, both organizations settled on a new, optional proxy for the entire credentialing process (read more about the rules here). However, it`s not a universal solution; many hospital bylaws don`t allow for credentialing by proxy, and it could violate state law – so be aware of the regulations in your facility and state before you decide which way to go. (x)
Prepping your Documents
Just like in any other credentialing process, you`ll need to gather a library of documents on your providers before you start. Chances are that your providers haven`t applied for out-of-state licensure before, though, so start by researching the destination state medical board and making a checklist of its requirements.
Give yourself time to put together the documents you might need. Original documents like sealed transcripts or licensee cards can take weeks to request, so start the process early. Budget time for snail mail: if your provider is in California, but has a patient in Alaska, sending physical documentation by mail can be dicey. Identification for work authorization can be particularly hard to find – think of the last time you asked someone for a copy of their social security card or birth certificate – and harder to replace if lost. Also remember that if any of these documents expire during the credentialing process, you might have to start all over again. Seek out credentialing software that can set automatic alerts for you, and make sure that they also offer integrations with primary sources so you can get license updates at the push of a button. If you have the option to go electronic – do it. You can request mobile fingerprinting companies for on-site visits, switch to electronic forms that accept e-signatures, or use cloud document storage services so you can access them anytime.
Getting Paid
Telehealth license? Check. Hospital privileges? Check. Medicare reimbursement? Uh-oh. Unfortunately, this is where telehealth is the most nebulous – when it comes to getting paid. Currently, reimbursement procedures for telemedicine services are spotty and vary by payor. Right now, Medicaid will only reimburse telemedicine visits in 40 states, which can deter patients from getting the care they need. (5) What`s around the corner is more hopeful, though. If the Medicare Telehealth Parity Act passes, it will expand coverage for telehealth services both across specialties (particularly for therapists) and geographical regions (to include rural health clinics and small metropolitan areas). (6) While this particular bill isn`t certain yet – and American healthcare is in a constant state of flux – it`s worth staying abreast of new laws that will help you determine the best places to practice and get paid appropriately.
Keeping Calm and Credentialing On
The thing about telemedicine providers is that it`s not uncommon for them to have licenses in multiple states – the average is around 15 states per provider. If you`ve got a small practice of 10 providers, you`re looking at 150 separate credentialing applications. Scale up to a whole hospital… and you`re going to be swimming in them. So what do you do? Well, keep calm and credential on – we have some solutions.
We know that your first thought is “but I`ve always done it in Excel before!” Telemedicine just doesn`t work that way; heaps and heaps of paper aren`t manageable in Excel. You`re going to miss expiration dates and your providers won`t be allowed to practice, and that`s a problem. Even though you`re a credentialing superhero, you need some help. So start by looking into credentialing management software, and try following these tips to narrow down your list:
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Get an app tracker –
You need a system that can both remember the day you printed off Dr Jones` Florida telemedicine application and remind you that you never sent it in. Look for credentialing management tools that include robust application tracking on a step-by-step basis. With that, you can handle deliverables for your team in real time and set realistic expectations for your forms and applications.
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Sign up for a password vault –
It doesn`t matter how patient your providers are; you don`t want to call them for their passwords each time you need to log into CAQH or a state medical board website. Most people keep passwords in a spreadsheet or locked in a file cabinet, but that`s a huge liability that you don`t want to be responsible for. Instead, sign up for a password vault – a secure (in techspeak, “encrypted”) system for storing usernames and passwords online (but where hackers can`t get to it). Better yet, check out the credentialing platforms that have a built-in login management tool. They`ll be tailored to healthcare-related websites and you won`t have to switch between systems as much.
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Upgrade your peer reviews –
Once again, paper is not your friend. You might be used to assigning peer reviews to your providers in sealed manila envelopes, but there will come a day when the wrong envelope ends up on the wrong desk… and you know what happens next. Instead, try an online peer review module that`s built into your credential management software. It`ll let you privately assign, view, and track reviews, plus your providers will be able to confidentially review each other. Just remember that not all websites are created equal; if you`re planning on discussing protected health information (PHI) in these reviews, check with your facility`s legal team about HIPAA requirements.
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Prepare for a transition –
Whether you`ve been toughing it out with the Microsoft Office suite, or you`re ready to jump ship from a 1990s-era credentialing software installation that`s taking up 50% of your hard drive, you`re going to have a lot of data to move around, and you`re not going to trust just anyone with it. As you`re talking to credential management platforms, ask them how they plan to move your old data over. Do they have an integration? Awesome. Can they handle a 30GB data export with ease? Definitely a yes. What about all your paper documents? Well, there are these things called scanners… Whoever you choose, make sure that they have an implementation team that`s ready to handle your data securely, quickly, and without any glaring gaps.
So are you ready to take on telemedicine credentialing? We hope this guide helps you navigate a tricky new aspect to credentialing – and be prepared for its evolution as the laws and customs around telemedicine change and grow. Let us know what worked for you in the comments – we`re always here to listen.
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