CPCS Telemedicine Credentialing and Privileging Standards 4 — Questions and Answers
Question 1: A critical access hospital (CAH) uses a telemedicine agreement with an urban hospital for emergency radiology coverage. Under CMS rules, who is responsible for granting privileges to the teleradiology provider?
- The urban hospital's credentialing committee acts as the sole authority
- The CAH must grant its own privileges based on the urban hospital's credentialing decisions (Correct answer)
- The state health department must approve the teleradiology arrangement
- The teleradiologist's professional society issues the required credentials
Correct answer: The CAH must grant its own privileges based on the urban hospital's credentialing decisions
Even under proxy credentialing, the CAH retains responsibility for formally granting privileges to the telemedicine provider using the distant site's credentialing process.
Question 2: What does NPDB stand for and what is its primary function in telemedicine credentialing?
- National Physician Database — stores physician demographic and contact information
- National Practitioner Data Bank — reports and queries adverse actions and malpractice payments (Correct answer)
- National Provider Directory Board — maintains provider enrollment information for CMS
- National Privileging Data Bureau — tracks hospital credentialing decisions nationally
Correct answer: National Practitioner Data Bank — reports and queries adverse actions and malpractice payments
The NPDB is a federal repository that collects and releases information about adverse actions, malpractice payments, and certain negative credentialing decisions affecting practitioners.
Question 3: Which body of law primarily governs the standard of care applicable to telemedicine encounters in the United States?
- Federal telemedicine statutes enacted by Congress
- State law in the jurisdiction where the patient is located (Correct answer)
- State law in the jurisdiction where the provider is located
- International telemedicine standards adopted by the WHO
Correct answer: State law in the jurisdiction where the patient is located
In telemedicine, the standard of care is generally governed by the laws of the state where the patient is physically located at the time of the encounter.
Question 4: A hospital's medical staff bylaws require all practitioners to hold a valid DEA registration. A telemedicine provider delivers only behavioral health counseling services without prescribing. How should this be handled?
- The provider must obtain a DEA registration to comply with bylaws regardless of prescribing activity
- The medical staff can grant an exception if the provider's scope does not include prescribing controlled substances (Correct answer)
- The telemedicine provider is exempt from all state and federal requirements
- The provider must obtain DEA registration in every state where they provide telemedicine services
Correct answer: The medical staff can grant an exception if the provider's scope does not include prescribing controlled substances
Medical staffs may grant exceptions to DEA registration requirements for practitioners whose privileges do not include prescribing controlled substances.
Question 5: In telemedicine credentialing, what is 'OPPE' designed to measure?
- A provider's compliance with billing and coding requirements
- A practitioner's ongoing clinical competency and performance based on data over time (Correct answer)
- The technical quality of a provider's telemedicine equipment setup
- A provider's satisfaction scores from telemedicine patients
Correct answer: A practitioner's ongoing clinical competency and performance based on data over time
OPPE uses aggregate data on clinical performance, outcomes, and professional conduct to evaluate ongoing competency between formal reappointment cycles.
Question 6: A telemedicine company contracts with 50 hospitals to provide hospitalist coverage. Which credentialing model would be MOST efficient for managing this arrangement?
- Each hospital independently conducts full primary source verification for every provider
- The telemedicine company obtains URAC or NCQA accreditation as a CVO to streamline credentialing (Correct answer)
- Each provider self-certifies their credentials for each contracted hospital
- The state medical board assumes credentialing responsibility for all contracted providers
Correct answer: The telemedicine company obtains URAC or NCQA accreditation as a CVO to streamline credentialing
An accredited CVO centrally manages primary source verification, allowing hospitals to rely on verified data rather than each conducting independent full verifications.
Question 7: Which scenario represents a conflict of interest that should be disclosed during a telemedicine provider's credentialing process?
- The provider is board-certified in a specialty relevant to the requested privileges
- The provider has a financial investment in the telemedicine technology platform used by the hospital (Correct answer)
- The provider completed residency at an institution affiliated with the hospital system
- The provider previously served on a medical staff committee at another facility
Correct answer: The provider has a financial investment in the telemedicine technology platform used by the hospital
A financial interest in the telemedicine platform creates a potential conflict of interest that must be disclosed to ensure objectivity in care delivery decisions.
CPCS Telemedicine Credentialing and Privileging Standards 4
A critical access hospital (CAH) uses a telemedicine agreement with an urban hospital for emergency radiology coverage.
Under CMS rules, who is responsible for granting privileges to the teleradiology provider?