What is Telehealth Credentialing?

Here’s why it matters:

Patient Safety and Quality of Care

First and foremost, telehealth credentialing protects patients. By thoroughly vetting providers before they can offer virtual care, healthcare organizations help ensure that patients receive quality care from qualified professionals. This verification process confirms that providers have the necessary training and expertise to deliver care in a virtual environment, which requires a unique set of skills beyond traditional in-person care.

Regulatory Compliance

Healthcare is one of the most heavily regulated industries, and telehealth adds another layer of complexity. Different states have different licensing requirements, and providers must be properly credentialed in each state where they practice telehealth. Non-compliance can lead to severe penalties, including fines, loss of license, and potential legal action.

Reimbursement Assurance

For healthcare organizations, proper credentialing directly affects the bottom line. Medicare, Medicaid, and private insurers typically require providers to be fully credentialed before they’ll reimburse for telehealth services. Without proper credentialing, claims may be denied, leading to revenue loss.

Institutional Reputation

In an era where patients have more choices than ever, reputation matters. Healthcare organizations that prioritize thorough credentialing demonstrate their commitment to quality care, which can enhance their standing in the community and attract more patients.

While the specifics may vary between organizations, the telehealth credentialing process typically follows these steps:

1. Application Submission

The process begins when a provider submits an application to offer telehealth services. This application includes detailed information about their education, training, work history, licenses, certifications, and references.

2. Primary Source Verification

Next, the credentialing team verifies this information directly with primary sources. This means contacting medical schools, residency programs, previous employers, licensing boards, and certification agencies to confirm the provider’s credentials.

3. Background Checks

Comprehensive background checks are conducted to identify any red flags, such as malpractice claims, disciplinary actions, or criminal history.

4. Committee Review

After gathering and verifying all necessary information, a credentialing committee reviews the provider’s application. This committee typically consists of medical professionals who evaluate the provider’s qualifications and determine whether they meet the organization’s standards.

5. Privileging

If approved, the provider is granted specific privileges that outline what services they can provide via telehealth. These privileges are based on the provider’s training, experience, and competency.

6. Ongoing Monitoring

Credentialing isn’t a one-time process. Providers must be re-credentialed periodically (usually every two to three years), and their performance is monitored continuously to ensure they maintain the required standards.

Telehealth credentialing comes with unique challenges and considerations that don’t apply to traditional credentialing:

Multi-State Licensing

One of the biggest challenges in telehealth credentialing is managing licenses across multiple states. Since providers must be licensed in the state where the patient is located during the telehealth encounter, those who wish to practice across state lines need multiple state licenses.

Some relief has come through interstate licensure compacts like the Interstate Medical Licensure Compact (IMLC), which streamlines the licensing process for physicians in participating states. However, not all states participate, and similar compacts don’t exist for all healthcare professions.

Credentialing by Proxy

To simplify the credentialing process for telehealth providers who practice at multiple facilities, the Centers for Medicare & Medicaid Services (CMS) allows for “credentialing by proxy.” Under this arrangement, a hospital can rely on the credentialing and privileging decisions of another hospital or telemedicine entity, rather than duplicating the entire process.

This approach can significantly reduce administrative burden, but it requires careful documentation and clear agreements between facilities.

Telehealth-Specific Competencies

Virtual care delivery requires skills that may not be necessary for in-person care. These include proficiency with telehealth technology, effective virtual communication, and the ability to perform remote assessments and diagnoses. Some organizations include evaluation of these telehealth-specific competencies in their credentialing process.

Despite its importance, telehealth credentialing comes with several challenges:

Time-Consuming Process

Traditional credentialing can take 60-120 days to complete, and telehealth credentialing may take even longer due to the additional complexities involved. This delay can hinder an organization’s ability to quickly implement or expand telehealth services.

Varying State Requirements

Each state has its own licensing requirements and credentialing standards, making it difficult for providers to practice telehealth across state lines. Keeping track of these varying requirements can be a logistical nightmare.

Technology Integration Issues

Many healthcare organizations struggle to integrate their telehealth platforms with their credentialing management systems, leading to inefficiencies and potential errors.

Resource Constraints

Proper telehealth credentialing requires significant resources, including dedicated staff, sophisticated software, and ongoing training. Smaller healthcare organizations may struggle to allocate these resources effectively.

To overcome these challenges and streamline the telehealth credentialing process, healthcare organizations can adopt these best practices:

Implement Digital Credentialing Solutions

Modern credentialing software can automate many aspects of the process, reducing administrative burden and minimizing errors. These solutions can track license expiration dates, send automatic reminders, and generate comprehensive reports.

Develop Clear Policies and Procedures

Establish clear policies that outline your organization’s telehealth credentialing requirements and processes. These policies should address state-specific requirements, privileging criteria, and ongoing monitoring procedures.

Centralize Credentialing Operations

Consider centralizing your credentialing operations to improve efficiency and consistency. A centralized team can develop expertise in telehealth-specific requirements and ensure uniform application of standards across your organization.

Stay Informed About Regulatory Changes

Telehealth regulations are constantly evolving, particularly in the post-COVID era. Assign responsibility for monitoring these changes and updating your credentialing processes accordingly.

Leverage Credentialing by Proxy When Appropriate

When possible, utilize credentialing by proxy arrangements to reduce duplication of efforts. Just be sure to establish clear agreements and maintain proper documentation.

Prioritize Provider Education

Educate your providers about the importance of telehealth credentialing and what the process entails. Clear communication can help reduce frustration and ensure smoother credentialing experiences.

Here are some trends to watch:

Standardization Efforts

There’s growing recognition of the need for more standardized credentialing processes across states and healthcare organizations. Initiatives like the IMLC represent steps in this direction, and we can expect more such efforts in the future.

Technology Advancements

Emerging technologies like blockchain could revolutionize credentialing by creating secure, tamper-proof credential verification systems. Artificial intelligence might also play a role in streamlining primary source verification and identifying potential red flags.

Regulatory Changes

The pandemic prompted temporary relaxation of some telehealth regulations, including those related to credentialing. As we move forward, we’ll likely see more permanent regulatory updates that reflect the growing importance of telehealth in our healthcare system.

Focus on Telehealth-Specific Competencies

As telehealth becomes more sophisticated, credentialing processes will likely evolve to more thoroughly assess providers’ telehealth-specific skills and competencies.