Under the CMS conditions of participation (COPs), the agency historically has accepted hospitals into the Medicare program if they have been accredited by the Joint Commission. The Joint Commission's "privileging by proxy" rule requires telemedicine providers to go through the credentialing and privileging process only once, at the facility providing the telemedicine service. These credentials were automatically accepted at the remote site receiving telemedicine service.
However, the Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 stipulates that as of July 15, 2010, Joint Commission accreditation is no longer recognized by CMS. As a result, physicians providing telemedicine services would have to be accredited at remote hospitals in addition to the facilities providing the service in order to meet COPs requirements.
CMS said that it has recognized that this requirement is duplicative and would put an undue burden on small hospitals, particularly those in rural areas. In addition, small hospitals often do not have in-house medical staff with the clinical expertise to adequately evaluate and privilege the wide range of specialty physicians that larger hospitals can provide through telemedicine services.
Instead, CMS is proposing to revise its COPs to state that when telemedicine services are provided through an agreement with a hospital at a distant site that participates in the Medicare program, it is the responsibility of the distant-site hospital to ensure that staff meets credentialing and privileging requirements.
CMS is accepting comments on the change through 5 p.m. Eastern Daylight Time on July 26, 2010. Comments can be submitted by clicking here and referring to file code CMS-3227-P.
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