5 Tips for Telemedicine Provider Credentialing 2022

The Centers for Disease Control and Prevention led a study on the use of telemedicine before and during the pandemic. The research revealed that patients used telemedicine 50% more in the first quarter of 2020 than they did in the same time frame in 2019.

Moving forward, it also recorded a 154% increase in the use of telemedicine around the 13th week of 2020. Given the unprecedented situation, the numbers are hardly surprising. The surprising fact here is that though the demand for telehealth has increased by leaps and bounds, the insurance provider credentialing has not gotten easier.

The government and private insurance carriers have certainly made some temporary changes to simplify the process for healthcare providers. But the steep denial rate in telemedicine provider credentialing shows how the process is still far from easy. You need to keep yourself updated on the latest guidelines and know the right process to apply for a position on the insurance network.

This article will give you some vital tips needed to start with your provider credentialing process in 2021 as a telemedicine provider. Read on to know more.

1.Accurate Facility Details:

  • When it comes to telemedicine, the facility details are of utmost importance. There have been several instances where incorrect or overlooked facility details have thrown the provider credentialing process off its track.
  • Complete address details along with their proof arecrucial for filling in the provider credentialing forms.
  • You will still need a valid address though you provide your services online. In this case, your home address will not suffice.
  • There are different clinic models that you can follow as a telehealth provider. Even if it is a “telehealth-only” model, you need to have a designated address.
  • You cannot put in a virtual office address in its place. If you do, it will be, in all probabilities, lead to insurance denial.
  • It would help if you also mentioned that your office address is not a clinic where patients come in person for treatment. This will prevent your address showing up on provider directories.

2.Fixing the Clinic Model for Successful Provider Credentialing:

  • There are many kinds of clinic models that you can follow if you want to choose telemedicine.
  • Several payer networks in the country have different policies when it comes to granting request for participating in their network.
  • Broadly, you can either have a hybrid model or a telehealth-only model.
  • As the name suggests, in a telehealth-only model, you complete your provider credentialing only as a telemedicine provider.
  • On the other hand, in a hybrid model, you offer both in-person visits to your clinic and provide telemedicine services.

To know the provider credentialing process for this model, you can read the article here.

  • According to experts, a larger part of the payer networks prefer hybrid models for their system. The statistics show that providers with hybrid models had a greater acceptance rate that the telehealth-only model.
  • However, with the rapidly changing scenario in the healthcare industry, you can target any model of your choice. All you need to do is apply to the suitable payer networks.

3.Out-of-state License Validity:

  • The telemedicine provider credentialing rules with respect to licensing requirements have been shuffled many times in the last few months owing to the pandemic.
  • The primary rule is that the provider must hold a valid state license where they are practicing. In case of telemedicine, this means that the provider should hold a license where the patient is located.
  • However, the Medical Licensure Compact, signed by 28 states, allows the providers to practice telemedicine in these states.
  • Hence the provider credentialing requirements change with the state that you practice in. Make sure you check whether your location falls under the participating states.
  • It would be best if you also kept a tab on the validity of the state license regularly. Expired paperwork during provider credentialing is one of the main reasons requests get denied.
  • As a way to combat the pandemic in 2020, the Coronavirus Preparedness and Response Supplemental Appropriations Act was passed.
  • This Act significantly did away with a great number of restrictions with respect to patient location in case of telemedicine services.
  • However, many of the clauses of the Act were temporary. Make sure you know the latest guidelines when you complete your provider credentialing process.

4.Provider Credentialing for Government and Private Payer Networks:

  • It is advisable to target both Government and private payer networks when opting for telemedicine services.
  • The Centers for Medicare and Medicaid Services has altered several telehealth payment rules in 2021.
  • Make sure your facility address is updated when applying to CMS. Site visits to incorrect addresses might lead to cancellation of your application.
  • CMS added as many as 144 telemedicine services temporarily in its 2021 payment rule. It has also added a number of such services permanently. Most of the permanent services focus on psychotherapy and home health.
  • Keep an eye on regular resources published on the CMS portal to know which rules are valid at the moment.

To know more about the CMS Payment Rule 2021, you can read the article here.

  • Private payer networks also change their rules frequently with the growing demand of telehealth. However, you have to check when they have a suitable seat open to apply on time.
  • Tracking several resources for Government payer network and open seats in private payer networks can be intimidating and exhausting as a full-time healthcare provider.
  • You can outsource these services to leading RCM companies who are well experienced in these domains, to get the correct and updated information.

5.Keep your options open:

  • There are several payer networks where you can apply to as a telehealth provider.
  • It is advisable to move according to a plan with a prioritized set of networks. But it is smart to keep another set ready in case your insurance provider credentialing gets denied in the first one.
  • While you should try for the leading payer networks in the country, you should also delve deeper into the local demand at your location.
  • In some cases, a greater volume of patients in a particular location are enrolled in a local health plan.
  • Make sure you try to apply to these networks as well to improve your patient base.
  • You can get in touch with leading outsourcing provider credentialing services to analyze the best options that you have.

We hope this blog helped you with telemedicine provider credentialing in 2021. If you have any further questions, please reach out to us in the comment section below. We will definitely get back to you. For more updates on healthcare technology and management, please subscribe to our blog. Do not forget to follow us on Facebook, Instagram, LinkedIn, and Twitter for regular updates.




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