Question of the Week

Question: We use “proxy credentialing” for our telemedicine providers, relying on the credentialing and privileging decisions of the Medicare-certified distant site hospital where the providers are located. Can we also rely on the distant site’s Data Bank queries, or do we need to query the NPDB on our own for each of our telemedicine providers?

Answer: CMS simply does not address this issue, based on a review of the preambles to the proposed and final telemedicine regulations, the applicable regulations themselves (including those that are cross?referenced in the telemedicine regulations), a CMS survey and certification memo on the topic, and the CMS web page.  The telemedicine credentialing rules do not specifically address whether an NPDB query that is performed by either (1) a “distant” hospital (i.e., the hospital where the telemedicine practitioner is located) or (2) a telemedicine entity (i.e., a telemedicine group) may be used by the hospital where the patient is located.

Because the telemedicine regulations do not address this issue, it is necessary to review the general NPDB rules to see what they say about sharing query information.  The NPDB regulations permit a hospital to use an “authorized agent” to perform queries on its behalf.  See, 42 C.F.R. §60.12(a).  Thus, the hospital where the patient is located could designate a distant hospital (or a telemedicine entity) as an “authorized agent” to perform a query on its behalf.

However, there is an important caveat.  The “authorized agent” must perform a separate query for each hospital.  Thus, a distant hospital (or a telemedicine entity) could not perform a single query, with that query then being used by each hospital that wants to use a telemedicine physician to provide services to its patients.  Here is the relevant guidance from the NPDB Guidebook:

The agent is explicitly prohibited from using information obtained from the NPDB for any purpose other than that for which the disclosure was made.  For example, two different health care entities designate the same authorized agent to query the NPDB on their behalf. Both health care entities wish to request information on the same practitioner. The authorized agent must query the NPDB separately on behalf of each health care entity. The response to an NPDB query submitted for one health care entity cannot be shared with another health care entity.  (Emphasis added.)

NPDB Guidebook, page B-7.

Thus, the “streamlined” credentialing process described by CMS in the telemedicine regulations will not work for NPDB queries.  Instead, either the hospital where the patient is located or the “authorized agent” must query the NPDB separately for each telemedicine practitioner.