Telemedicine Credentialing by Proxy

A CMS provision allowing hospitals to rely on the credentialing decisions of another hospital or telemedicine entity when privileging distant-site telemedicine providers.

Credentialing by proxy is a CMS rule that simplifies hospital credentialing for telemedicine providers. Without this provision, a telemedicine provider would need to go through the full medical staff credentialing process at every hospital where they provide remote consultations, which could mean credentialing at dozens of facilities. Under credentialing by proxy, the originating site hospital (where the patient is located) can rely on the credentialing and privileging decisions made by the distant site hospital or telemedicine entity (where the provider is located). Instead of doing its own primary source verification, the originating site accepts the distant site's credentialing decisions. The originating site must still meet certain conditions to use credentialing by proxy. They must have a written agreement with the distant site. The distant site must be a Medicare-participating hospital or telemedicine entity. The distant site's credentialing process must meet Medicare Conditions of Participation. And the originating site must still review the distant site's credentialing information and make a privileging decision. This provision has become increasingly important as telemedicine expands. A telestroke program might have neurologists providing remote consultations to 30 different rural hospitals. Without credentialing by proxy, that neurologist would need 30 separate hospital credentialing applications, each taking months. With credentialing by proxy, the distant site credentials the provider once, and each originating site can rely on that credentialing. Credentialing by proxy applies specifically to hospital privileging for telemedicine. It does not apply to payer credentialing. You still need to be enrolled with each payer that covers the patients you see via telemedicine. And you still need a medical license in every state where your patients are located. If you are a telemedicine provider, ask each facility about their credentialing by proxy policies. Some facilities have embraced it and can onboard telemedicine providers in days rather than months. Others still require the traditional full credentialing process regardless of whether proxy is available.