Teleradiology Credentialing by Proxy – A Real Benefit?

What the New CMS Rule Means for Teleradiology Credentialing

On May 2, 2011, the Centers for Medicare and Medicaid Services (CMS) released a final rule that allows hospitals and critical access hospitals using teleradiology services the ability to rely on the credentialing and privileging information of the teleradiology group. However, hospitals are still responsible for making their own internal decisions to grant physicians privileges based upon their credentialing profile.

Benefits of Teleradiology Credentialing by Proxy

An examination of the benefits of “credentialing by proxy” should ease hospital concerns as well and motivate them to adopt the process. Some of the benefits of proxy credentialing are:
  • Increase patient access to services
  • Improve the quality of patient care
  • Reduce administrative procedures.

Proxy credentialing will give hospitals access to qualified remote physicians in a fraction of time that it currently takes. In teleradiology groups, teleradiologists are often credentialed at 50 or more hospitals across the country. During the credentialing process, each of those hospitals is required to provide a verification that a teleradiologist is currently “on staff.” This process alone can take months for a hospital’s medical staff to complete.

Teleradiology groups that are Joint Commission Accredited are required to primary source verify all hospital affiliations for teleradiologists. This information is saved in the physician file. Proxy credentialing allows the teleradiology group to share this information directly with the hospital – thereby dramatically reducing the verification time for the hospital.

Currently, it can take 3-6 months for a hospital to complete the credentialing process and get medical staff approval for a physician. By utilizing the new CMS rule, the process can be completed in just one month (or even less.)

The Fly in the Ointment

Hospitals have only 60 days (from the day the rule was finalized) to adopt it into the by-laws.

Though the benefits of this new rule are obvious, many administrators are wary of adopting it. The main concern is the timing; 60 days may not be enough time to vet out the process, conduct a by-laws committee meeting or adopt the new provision.

Trust is also an issue. In order for hospitals to take advantage of this new rule, there must be 100% confidence in the credentialing process of the teleradiology provider, which is difficult for many administrators to do. Nobody likes giving up control! Even the teleradiology providers that do have a thorough, accredited credentialing process, will still face an uphill battle to getting this rule adopted into by-laws of customer sites.

Teleradiology providers need to act quickly to alleviate some of these concerns. Hospitals should be fully educated on the teleradiology provider’s credentialing process. Teleradiology groups shouldn’t expect that just because they are Joint Commission Accredited, that hospitals will unconditionally accept the group’s credentialing process. Teleradiology medical staff managers should take time to explain the various policies and procedures that are in place to ensure hospital administrators that their physicians are accurately verified and credentialed. Communication and openness will go a long way to dismiss concerns from the hospitals in adopting the new CMS rule.

It’s also important to note that hospitals should still closely monitor the process and number of physicians being credentialed at the facility. Just because the process is “new and improved,” doesn’t mean that the hospital should allow any more teleradiologists than necessary to be credentialed.

My Final Answer

Teleradiology credentialing by proxy is a major step in the evolution of telemedicine and can provide significant time and cost savings. As long as the hospital staff is confident in the credentialing processes of the teleradiology provider, credentialing by proxy should be embraced as a way to improve access to quality physicians and ultimately, to improve patient care.

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