Louisiana medical psychologists telemedicine overview - the who, what, when, where and how to set up a compliant telemedicine practice 2014

104/10/2023Conrad Meyer JD MHA FACHE

Chehardy Sherman

LOUISIANA ACADEMY OF MEDICAL PSYCHOLOGISTS

Continuing Education ConferenceTelemedicine – Who, what, when, where

and how!

Conrad Meyer JD MHA FACHEHealth Care Sections

Chehardy Sherman Law [email protected]

(504) 830-4141

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Telehealth Services History

Pre January 1999 – CMS had limited coverage for services delivered via telecommunications

Did not require face to face meeting BBA – provided coverage

October 2001 – Benefits Improvement Protection Act (BIPA)

Expands telehealth services Adds – consults, office visits,

office psych services, and “any additional service specified by the Secretary”

Required interactive telecommunication system


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BIPA – Also provided annual updates to Telehealth services

Established a process for providers to request CMS add services to the list of telehealth services (CMS is very conservative)

Defined eligible telehealth individual – one who receives telehealth services at an “originating site”

Originating sites included: Practitioner Office; Critical Access Hospital

(CAH); rural health clinic (RHC); FQHC04/10/2023

Conrad Meyer JD MHA FACHE Chehardy Sherman

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MIPPA – Medicare Improvements for Patients and Providers Act (2008)

Expanded list of telehealth “originating sites” Now includes: Hospital

Based Renal Dialysis Centers; SNFs; and Community Mental Health Centers (CMHCs).

The added sites must be located in a rural health professional shortage area (HPSA); not in a Metropolitan Statistical Area (MSA)


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Telehealth Services Billing

To be reimbursed as Telehealth Services the following must happen:

Telehealth services must be furnished to eligible beneficiary at originating site

Originating site must be listed as approved by CMS

One of services listed as approved telehealth services by CMS

Performed by practitioner at distant site provided practitioner can perform services pursuant to state law via telecommunications system 04/10/2023


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Telehealth Services Billing

To be reimbursed as Telehealth Services the following must happen:

Practitioner shall be paid amount equal to amount practitioner would have been paid if the service were performed live

Proper modifiers must be used Facility fee is paid to originating site Be careful to code properly for telehealth services –

follow requirements – must be INTERACTIVE communication to be telehealth – NOT simply reading electrocardiogram by physician received by phone.


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Telehealth Services Barriers to Telehealth

Reimbursement Licensure Credentialing Liability


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Telehealth Services Reimbursement

Show me the money? – Medicare/Medicaid? Private Payors?

Medicare Requires – Real time two way communication via

Audio/Video between patient at distant site and practitioner Beneficiaries must meet eligibility – be at originating site in

a HPSA Must be medically necessary Distant site physician paid the same amount (by fee

schedule) if services were performed in his/her local area Distant site physician must be acting within scope of

practice Beneficiary pays copay/deductible Originating site gets facility fee (varies based on facility

type)


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Telehealth Services

Reimbursement Show me the money? – Medicare/Medicaid? Private Payors?

State Medicaid/Private Payors Usually look to Medicare for guidance No consistency – some full reimbursement others

outright deny claims Private Payors – vary by contractor

Telehealth venture’s should be wary of fee schedules and Medicaid reimbursement policies for telemedicine for each state it ventures to do business


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Telehealth Services Licensure

Multistate reach of services presents problems for providers

States individually license Some states have special purpose

telemedicine license Physicians should have compliance

program that identifies the state’s licensure issues in states the telehealth company desires to do business

Exception of common consultations may not apply if care involves telemedicine link


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Telehealth Services Licensure

Federation of State Medical Boards (FSMB)

Developed Model Act to regulate practice of medicine across state lines

Created special purpose license Louisiana has special purpose

telemedicine license – LSBME


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Telehealth Services Credentialing

Who’s job is it? CMS differs with TJC on credentialing

distant site physicians TJC uses a reciprocity approach - CMS does not – requires both distant and originating

hospital to follow full credentialing process; some flexibility for CAHs where CMS allows CAHs to enter into rural health networks for credentialing as opposed to going through process

DNV Healthcare, Inc (DNV) – new credentialing standards Approved by CMS in September 2008 as alternative

to TJC accreditation


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Telehealth Services Credentialin

g Who’s job is

it? TJC LSBME Facility? Distant

Site? Originating

Site?


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Telehealth Services Credentialing

Who’s job is it? TJC – CMS won battle

Effective 7/15/2010 – TJC revised standards to bring in line with CMS

New standards for TJC provide for 2 different processes: Hospitals that use TJC accreditation for

“deemed” status (most do for COPS) then telemedicine providers must be fully credentialed and privileged at originating site – See MS .06.01.03 and MS .06.01.13

Hospital that do NOT use TJC accreditation for “deemed” status can use TJC reciprocity approach.


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Telehealth Services Liability

Creating physician/patient relationship via telehealth What standard of care is to be applied? – Unknown

Texas holds online physician to same standard of care as physician conducting office consultation

Hawaii holds online physician to lesser standard Will liability coverage extend to online services? –

Unknown Website disclaimers – are they

enforceable/effective? – Unknown Most sites have disclaimers to limit liability – will they

shield physicians from liability? Will coverage extend to physician sites that simply offer

information with no rendering of care? – Likely not


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Telehealth Services Telepharmacies

New frontier – E-pharmacies – electronic prescriptions

Some states require specific regulations for e-prescribing

Most simply require telemedicine to be performed with appropriate standards of care

Rogue pharmacies are aggressive prosecuted and also tie activities to medical licensing sanctions – See SR 81


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DEA – issued guidance (2008) Regulations that affect physicians for e-

prescribing Require detailed procedures and system

requirements for: Health care providers who e-prescribe

controlled substances Service providers who create software and

systems for e-prescribing Pharmacies that dispense controlled substances

via e-presciption New regs present potential civil and

criminal liability04/10/2023Conrad Meyer JD MHA FACHE

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DEA – Rogues pharmacies on rise Enforcement on rise Ryan Haight Act –

enacted in 2008 – bans sale or distribution of prescription drugs over internet without a “valid prescription”

Defined “valid prescription” to require a practitioner to examine patient in person – limited exceptions


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Telehealth Services Tweet?

Social Media Explosion of Web 2.0 – live two way communication

Facebook Twitter

Concerns over Privacy – HIPAA/HITECH issues Some states regulate use of email/internet advertising and

websites by physicians Texas

Requires physicians to Disclose ownership of websites In-office contact information Licensure Qualifications of physician Compliant and feedback processes Disclosure of any financial interest


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Telehealth Services Informed Consent

Telemedicine – different and more crucial

Must clearly lay out telemedicine encounter Describing physician’s name/location Disclosures about use of video conference to

render services Potential risks for using telemedicine

Equipment failure? Some states have enacted laws to require

minimum standards for informed consent for telemedicine services Texas, Arizona and Kentucky


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Telehealth Services Informed Consent

Telemedicine – different and more crucial

Must clearly lay out telemedicine encounter Describing physician’s name/location Disclosures about use of video conference to

render services Potential risks for using telemedicine

Equipment failure? Some states have enacted laws to require

minimum standards for informed consent for telemedicine services Texas, Arizona and Kentucky


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Telehealth Services PPACA and Telehealth

Center for Medicare and Medicaid Innovation (within CMS)

Tests delivery of new payments and delivery arrangements

PPACA expands rural telehealth initiatives PPACA creates comprehensive review of Part D via

e-prescribing


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Telehealth Services Resolving the issues? Where do we

go? Licensure needs to be addressed –

national telemedicine license? Reimbursement? Credentialing – uniform system? Liability – Standards of care – at

originating site? Distant site?


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Telemedicine Defined

The practice of medicine when the doctor and patient are widely separated using two-way voice and visual communication (as by satellite or computer)


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How Telemedicine is Being Used

1. Digital Images a) Digital images are taken and

forwarded to another locationi. Used for x-rays, CAT Scans, MRIs any

other digital imageii. Used for non-emergency situations

2. Two-way Interactive Televisiona) Teleconferencing is used with the

patient in the roomi. Used for face-to-face consolationsii. Allows “real time” consultations to take

placeiii. Used mostly in an rural-to-urban

location or for examination by a specialist


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Who is Using Telemedicine

1. Specialista) Conferences with a specialist who is not in the area

2. Oncology3. Mental health care to people in jail 4. Hospice care5. School health services

a) Allowing school nurses to interact with physicians6. Home health care

a) Will be a huge area of telemedicine with the aging baby boomers7. Nursing homes


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Future of Telemedicine

1. Telesurgerya) Using robotic equipment to perform a

surgeryb) A surgeon in one location remotely

controls a robotic arm for surgery in another location

c) The military and others have been experimenting with this

i. http://www.mrcas.ri.cmu.edu/


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Advantages of Telemedicine

1. Specialty care is more accessible2. Video consultations keep cost down for

patients who would otherwise have to travel to a specialist

3. Keeps cost down for hospitals4. Faster turn around time for evaluation5. Frees beds of patients who can be monitored

from home6. More convent for doctors to see patients


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Disadvantages of Telemedicine

1. The laws and regulations have not caught up with the technology

2. Reimbursement issues3. Insurance issues


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Louisiana:Telemedicine Defined

La. R.S. 37:1262

1. The practice of health care delivery, diagnosis, consultation, treatment, and transfer of medical data using interactive telecommunication technology that enables a health care practitioner and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously.


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LouisianaRequirements for a Telemedicine

LicenseLa. R.S. 37:1276.1

A. The board shall issue a telemedicine license to allow the practice of medicine across state lines to an applicant who holds a full and unrestricted license to practice medicine in another state or territory of the United States.B. The board shall establish by rule in accordance with the Administrative Procedure Act the requirements for licensure under this Section provided the rules include the following:(1) The physician licensed under this Section shall not open an office in this state, shall not meet with patients in this state, and shall not receive calls in this state from patients.


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LouisianaRequirements for a Telemedicine

LicenseLa. R.S. 37:1276.1

(2) The physician, when examining a patient by telemedicine, shall establish a bona fide physician-patient relationship by:

(a) Conducting an appropriate examination of the patient as determined by the board.

(b) Establishing a diagnosis through the use of accepted medical practices including but not limited to patient history, mental status, and appropriate diagnostic and laboratory testing.

(c) Discussing with the patient any diagnosis as well as the risks and benefits of various treatment options.

(d) Ensuring the availability for appropriate follow-up care.(e) Fulfilling any other requirements as deemed appropriate and

necessary by the board.(3) The board may establish by rule additional qualifications, requirements, scope, and limitations of the use of telemedicine in this state as the board may deem appropriate.C. Any physician licensed to practice telemedicine in accordance with this Section shall be subject to the provisions of this Part, the jurisdiction of the board, applicable state law, and, with respect to providing medical services to state residents, to the jurisdiction of Louisiana courts.


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LouisianaTelemedicine License

La. R.S. 37:1271.(B)1-5

(1) No person shall practice or attempt to practice medicine across state lines without first complying with the provisions of this Part and without being a holder of either an unrestricted license to practice medicine in Louisiana or a telemedicine license entitling him to practice medicine pursuant to R.S. 37:1276.1(2)Except as provided in R.S. 37:1276.1, all of the following shall apply to any physician practicing telemedicine as defined in this Part:

(a) The physician practicing telemedicine shall use the same standard of care as if the healthcare services were provided in person.


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La. R.S. 37:1271.(B)1-5

(2)Except as provided in R.S. 37:1276.1, all of the following shall apply to any physician practicing telemedicine as defined in this Part (CONT.):

(b) The physician practicing telemedicine shall not be required to conduct an in-person patient history or physical examination of the patient before engaging in a telemedicine encounter if the physician satisfies all of the following conditions:

(i) Holds an unrestricted license to practice medicine in Louisiana. (ii) Has access to the patient's medical records upon consent of the

patient. (iii) Maintains a physical practice location within the state of

Louisiana or executes an affirmation with the board that the physician has an arrangement with another physician who maintains a physical practice location in Louisiana to provide for referrals and follow-up care which may be necessary.


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La. R.S. 37:1271.(B) 1-5

Except as provided in R.S. 37:1276.1, all of the following shall apply to any physician practicing telemedicine as defined in this Part:

(3) Except as authorized by rule promulgated by the board, no physician practicing telemedicine pursuant to this Subsection shall prescribe any controlled dangerous substance prior to conducting an appropriate in-person patient history or physical examination of the patient as determined by the board. (4) A patient receiving telemedicine services may be in any location at the time that the telemedicine services are rendered. A physician practicing telemedicine may be in any location when providing telemedicine services to a patient. (5) A physician practicing telemedicine shall document the telemedicine services rendered in the patient's medical records according to the same standard as that required for nontelemedicine services. Medical records including but not limited to video, audio, electronic, or other records generated as a result of providing telemedicine services shall be considered as confidential and shall be subject to all applicable state and federal laws and regulations relative to the privacy of health information.


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Louisiana Telehealth Act (LTA)LSA R.S. 40:1300.381 - .384

R.S. 40:1300.381 – TitleR.S. 40:1300.382 – Legislative Findings:

(1) As an innovative form of health care, telehealth is extremely valuable because it enhances access to care, particularly in rural locations and other medicallyunderserved areas; makes delivery of care more cost-effective; and distributes limited provider resources more efficiently.

(2) Many patients with limited access to traditional health care can be diagnosed and treated sooner through telehealth than they would be otherwise, resulting in improved outcomes and less costly treatments due to early detection and prevention.


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R.S. 40:1300.381 – TitleR.S. 40:1300.382 – Legislative Findings:

(3) Telehealth services could potentially address a great unmet need for health care by persons who have limited access to both traditional healthcare settings and to telemedicine as currently defined in Louisiana law.

(4) If this state is to achieve much needed improvement in health outcomes, a prudent and responsible policy for doing so would be to balance patient safety and access to care through expanding access to telehealth services for the people of Louisiana.


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R.S. 40:1300.383 – Definitions(1) "Asynchronous store and forward transfer" means the transmission of a patient's medical information from an originating site to the provider at the distant site without the patient being present. (2) "Distant site" means the site at which the healthcare provider delivering the service is located at the time the service is provided via a telecommunications system.


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R.S. 40:1300.383 – Definitions(3) "Healthcare provider" means a person, partnership, limited liability partnership, limited liability company, corporation, facility, or institution licensed or certified by this state to provide health care or professional services as a physician assistant, hospital, nursing home, dentist, registered nurse, advanced practice registered nurse, licensed practical nurse, certified nurse assistant, offshore health service provider, ambulance service, licensed midwife, pharmacist, speech-language pathologist, audiologist, optometrist, podiatrist, chiropractor, physical therapist, occupational therapist, certified or licensed athletic trainer, psychologist, medical psychologist, social worker, licensed professional counselor, licensed perfusionist, licensed respiratory therapist, licensed radiologic technologist, or licensed clinical laboratory scientist.


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R.S. 40:1300.383 – Definitions(4) "Originating site" means the location of the patient at the time the service is furnished via a telecommunications system or when the asynchronous store and forward transfer occurs. (5) "Synchronous interaction" means communication through interactive technology that enables a healthcare provider and a patient at two locations separated by distance to interact via two-way video and audio transmissions simultaneously. (6) "Telehealth" means a mode of delivering healthcare services that utilizes information and communication technologies to enable the diagnosis, consultation, treatment, education, care management, and self-management of patients at a distance from healthcare providers. Telehealth allows services to be accessed when providers are in a distant site and patients are in the originating site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers. Conrad Meyer JD MHA FACHE

Chehardy Sherman

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R.S. 40:1300.384 – Telehealth Rulemaking RequiredA. Each state agency or professional or occupational licensing board or commission that regulates the practice of a healthcare provider, as defined in this Part, may promulgate, in accordance with the Administrative Procedure Act, any rules necessary to provide for, promote, and regulate the use of telehealth in the delivery of healthcare services within the scope of practice regulated by the licensing entity.

B. The rules shall, at a minimum, provide for all of the following: (1) Application of all laws regarding the confidentiality of

healthcare information and the patient's rights to the patient's medical information created during telehealth interactions.

(2) Application of the same standard of care by a healthcare provider as if the healthcare services were provided in person.


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R.S. 40:1300.384 – Telehealth Rulemaking Required

B. The rules shall, at a minimum, provide for all of the following: (3)(a) Licensing or registration of out-of-state healthcare

providers who seek to furnish healthcare services via telehealth to persons at originating sites in Louisiana. The rules shall ensure that any such healthcare provider possesses, at a minimum, an unrestricted and unencumbered license in good standing to perform the healthcare service in the state in which the healthcare provider is located, and that the license is comparable to its corresponding license in Louisiana as determined by the respective Louisiana licensing agency, board, or commission.

(b) Each state agency and professional or occupational licensing board or commission is authorized to provide by rule for a reasonable fee for the license or registration provided for in this Subsection.

(4) Exemption from the telehealth license or registration required by this Subsection for the consultation of a healthcare professional licensed by this state with an out-of-state peer professional.


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R.S. 40:1300.384 – Telehealth Rulemaking Required

C. Nothing in this Part shall be construed to authorize a state agency or professional or occupational licensing board or commission to expand, diminish, or alter the scope of practice of any healthcare provider.


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LouisianaTelemedicine: Establishing a

Physician/Patient Relationship 1. Conduct an appropriate examination of the patient as

determined by the Louisiana Board of Medical Examiners

2. Establish a diagnosis through the use of accepted medical practices including but not limited to patient history, mental status, and appropriate diagnostic and laboratory testing

3. Discussing with patient the risks and benefits of various treatment options

4. Ensuring the availability of follow-up care5. Fulfillment of any other requirements deemed by the

Louisiana Board of Medical Examiners as necessary


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Telemedicine – Are Providers/Hospitals Ready?

1. Numerous legal/business/quality issuesa) Three include:

i. Licensurea. Liability b. Jurisdictionc. Insurance Coverage

ii. Credentialinga. Qualityb. Standards

iii. Business Modela. Reimbursementb. Local Docs v. Telemedicine Docsc. Medical Staff reactions to Telemedicine Issued. Cost Issues – Telemedicine v. in-house services


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Telemedicine Licensure

1. Louisianaa) Enacted 2008 Sessionb) See La. R.S. 37:1276.1

2. Compare to other statesa) Texasb) Californiac) Kentucky


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Federation of State Medical Boards

Telemedicine Licensure 1. The Federation of State Medical Boards (FSMB) is a national non-profit

organization whose membership includes 70 medical licensing and disciplinary boards in the United States, and the U.S. territories.

2. Mission is for the FSMB to support state medical boards (1) as primary vehicles of medical licensure and discipline and (2) in developing and using consistent standards, language, definitions and tools.

3. FSMB weighed in on Telemedicine Licensure issues and determined that a set of standards for expedited licensure determination

4. The report sets forth the expedited licensure process for physicians meeting identified and accepted standards and is dependent upon the development of a standard medical license application and acceptance of established standards for primary source verification of physician core credentials, including identity, medical education, postgraduate training, examination, and disciplinary history.

5. The issue to be addressed was portability – physicians realized that licensure was a barrier to access to various states

6. FSMB – addressed issue of standardized licensure applications - recommended


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FSMB RequirementsExpedited Licensure – Portability

Requirements for Expedited Licensure from FSMB:

1. Full and unrestricted licensure (in all jurisdictions where a medical license is held);

2. Free of disciplinary history, license restrictions, or pending investigations (in all jurisdiction where a medical license is or has been held);

3. Graduation from an approved medical school or hold current Educational Commission for Foreign Medical Graduates (ECFMG) certification;

4. Passage of a licensing examination acceptable for initial licensure within three attempts per step/level and within a seven (7) year time period;

5. Completion of three (3) years of progressive postgraduate training in an accredited program; and/or,

6. Current certification from a medical specialty board recognized by the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA). Lifetime certificate holders who have not passed a written specialty recertification examination must demonstrate successful completion of the Special Purpose Examination (SPEX), Comprehensive Osteopathic Medical Variable Purpose Examination (COMVEX), or applicable recertification examination.


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Telemedicine Licensure IssuesLouisiana

1. La. R.S. 37:1276.1 – Initial legislation is a great start at catching up with technology

2. Needs to be revised however as statute leaves open several issues:

a) Jurisdictioni. What jurisdiction is out of state physician licensed pursuant to La.

R.S. 37:1276.1 subject to in a lawsuit with La. Patient?b) Liability

i. Is out of state physician licensed pursuant to La. R.S. 37:1276.1 covered under La. MMA?

c) Coveragei. What coverage does out of state physician licensed pursuant to

La. R.S. 37:1276.1 need?a. How will they by qualified under PCF?

d) Corporate Practice of Medicine issues – See LSBME website for current position of CPM

e) Aiding and Abetting – Are hospital’s liable for contracting with physicians who don’t comply with La. R.S. 37:1276.1?


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Telemedicine Licensure IssuesLouisiana

1. How do we solve these issues?a) La. R.S. 37:1276.1 – leaves open ended rulemaking by LSBME

i. Any other rules and the Louisiana Board of Medical Examiners establish

ii. LSBME could establish rules addressing jurisdiction, liability, coverage, CPM, etc.

b) Legislature can amend La. R.S. 37:1276.1 to address these issues as well

i. Jurisdictiona. Statute could be amended requiring any physician to submit

him/herself to jurisdiction of Louisianab. Statute could delineate jurisdiction by location of patient – not

physicianii. Liability

a. Statute could be amended to designate physician licensed pursuant to La. R.S. 37:1276.1 would subject himself to MMA

iii. Coveragea. Statute could be amended to require any physician licensed

pursuant to La. R.S. 37:1276.1 to qualify with the PCF b. Statute could require minimum coverage standards for

insurance purposes


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Telemedicine Credentialing Issues

1. Appointment, Reappointment and Delineation of Clinical Privileges

2. Physicians +

3. Heavily Regulated ,CMS, state, TJC


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Areas of Frequent LitigationCredentialing Issues -

Telemedicine1. Contractual Challenges

2. Bylaws

3. Host of Other Theories


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Telemedicine Credentialing

1. Was Secondary to Licensure

2. TJC Medical Staff Standards – Required sites receiving telemedicine services to credential and privilege , including radiologists, pathologists, consultants (See MS.4.120)

3. 2004 “ New JCAHO Standard” to reduce the burden on patient location sites


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TJC Standards for Telemedicine Credentialing

(MS.13.01.01) - Applies to Licensed Independent Practitioners (LIPs) at Originating sites Licensed independent practitioners who are responsible for the care, treatment, and services of the patient via telemedicine link are subject to the credentialing and privileging processes of the originating site.


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TJC MS.13.01.01

(MS.13.01.01) - Element of Performance for MS.13.01.01A 1. All licensed independent practitioners who are responsible for the patient’s care, treatment, and services via telemedicine link are credentialed and privileged to do so at the originating site through one of the following three mechanisms:

1. The originating site fully privileges and credentials

the practitioner according to Standards MS.06.01.03

through MS.06.01.13; orConrad Meyer JD MHA FACHE

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TJC MS.13.01.01

(MS.13.01.01) - Element of Performance for MS.13.01.01

2. The originating site privileges practitioners using credentialing information from the distant site if the distant site is a Joint Commission accredited organization. The distant site practitioner has a license that is issued or recognized by the state in which the patient is receiving telemedicine services; or


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TJC MS.13.01.01


3. The originating site may choose to uses the credentialing and privileging decision from the distant site to make a final privileging decision if all the following requirements are met:

1. The distant site is a Joint Commission accredited hospital or ambulatory care organization.

2. The practitioner is privileged at the distant site for those services to be provided at the originating site.

3. For hospitals that use Joint Commission accreditation for deemed status purposes: The distant site provides the originating site with a current list of licensed independent practitioners’ privileges.

4. The originating site has evidence of an internal review of the practitioner’s performance of these privileges and sends to the distant site information that is useful to assess the practitioner’s quality of care, treatment, and services for use in privileging and performance improvement. At a minimum, this information includes all adverse

outcomes related to sentinel events considered reviewable by The Joint Commission that result from the telemedicine services provided; and complaints about the distant site licensed independent practitioner from patients, licensed independent practitioners, or staff at the originating site. (See also LD.04.03.09, EP 9)


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TJC MS.13.01.01


1. The distant-site practitioner has a license that is issued or recognized by the state in which the patient is receiving telemedicine services.


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TJC LD 04.03.09

Standard:Care, treatment, and services provided through contractual agreement are provided safely and effectively


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TJC LD 04.03.09

Elements:For hospitals that use Joint Commission accreditation for deemed status purposes: The originating site has a written agreement with the distant site that specifies the following:1. The distant site is a contractor of services to the

hospital.2. The distant site furnishes services in a manner

that permits the originating site to be in compliance with the Medicare Conditions of Participation.

3. The originating site makes certain through the written agreement that all distant site telemedicine providers’ credentialing and privileging processes meet, at a minimum, the Medicare Conditions of Participation at 42 CFR 482.12(a)(1) through (a)(9) and 482.22(a)(1) through (a)(4). (See alsoMS.13.01.01, EP 1)


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Example – Applying

1. Dr. X is a credentialed specialist at distant site General Hospital A

2. Originating site Small Hospital B, if it choices, may require Dr. X to be privileged and credentialed in order to treat patients in B via telemedicine or

3. Hospital B may use Dr. X’s credentialing data from Hospital A if it is a TCJ accredited hospital


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Examples Cont.

1. Hospital B may use Hospital A ‘s credentialing and privileging information:

a) if A is TJC accreditated,b) if X is privileged by A for the services

performed at B,c) if B has evidence of an internal review

of X’s performance of these privileges and sends to A , X’s performance data from B that is useful in A’s quality reviews of X and in X’s re-credentialing


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TJC Credentialing

1. Reduces credentialing and privilege burden for the originating site

2. Recognizes that the distant site has the key information for which it based its privilege decisions

3. Acknowledges that originating site might not have experience to credential/privilege certain specialties Conrad Meyer JD MHA FACHE

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Where are we headed?

1. Telemedicine is only going to expand

a) Use of Internet and other technologiesb) Diagnostic Services – via telemedicinec) Remote monitoringd) Remote surgery

2. Legal/Business/Quality Issues will need to be addressed on an ongoing basis



Chehardy Sherman

Questions Please contact:CONRAD MEYER JD MHA FACHE

Health Care Section - Chehardy Sherman

One Galleria Blvd Suite 1100

Metairie, La. 70001

(504) 830-4141

[email protected]

mailto:[email protected]