Do's & Don'ts For Imaging Center Claims Submission

Do	Make sure the beneficiary's name matches their ID card exactly.
Do	Use the right modifiers. Make sure you have used the appropriate modifier (-51 is the most problematic, carriers say).
Do	List the Medicare identification number (UPIN) for the provider.
Do	Check your codes against the CCI list to determine which CPT® codes can be billed together for Medicare. Some insurance carriers will follow  Medicare's determination of which CPT® codes can be billed together.
Do	Use the correct diagnosis code for the service. This is a common problem and frequent reason for denials. Check that you haven't submitted a  three-digit code when a fourth- or fifth-digit code exists (remember, you must code to the highest degree of specificity), or made any typographical  errors.
Do	List your Clinical Laboratory Improvement Amendments (CLIA) identification number for claims containing laboratory tests performed in your office.
Do	Properly list purchased diagnostic tests. Those diagnostic services with a professional and technical component are subject to the "purchased  diagnostic" provision of the Medicare program. Carriers may decide whether or not the physician performed both components (i.e., did not purchase  one of the components from an outside source). To signify whether the test was both performed and interpreted in the physician's office, some  carriers require the use of locally assigned codes. Check with your carrier for local guidelines.
Don't	Submit an operative report and a cover letter for claims filed with unlisted CPT codes or CPT codes with modifier 22, Unusual procedural service.  Wait until the carrier sends a request for documentation. When the request comes in, then send your documentation to include the operative report  and cover letter. Remember, the operative report is the documentation that describes the procedure performed for which there is no appropriate  CPT code or explains what was unusual about the service to warrant additional payment to support modifer 22. The cover letter should detail the  procedure performed, explain in layman's terms why the procedure was different, took a longer amount of time or why a higher skill level was  required, as the clerk who reviews your claim may not have extensive medical knowledge. This is a change due to the mandatory electronic claim  submission implemented by Medicare in July 2005.
Don't	Bill for a visit that is included in the global period for a surgery or procedure. This rule only applies to those codes with a global period. Remember,  you cannot bill for a visit that is used to perform a surgical procedure. Only if the decision to perform the surgery was made during the visit (and  modifier -57, Decision for Surgery, is used) can you bill for both the visit and the procedure.
Don't	Re-submit returned or rejected claim forms. If your claim is returned or rejected for any reason, re-submit a completely new claim. Do not resend  the old one and mark it "corrected." This will only result in a second rejection.
Don't	Bill for an unrelated visit during the postoperative period without modifier -24, Unrelated E&M Service by the Same Physician During a Postoperative  Period. A visit during the postoperative period must be unrelated to the surgery to be billed and must include modifier -24. The diagnosis code for  this visit should be for something completely unrelated.
Don't	Automatically resubmit a claim. Remember, it takes roughly 13 days to process an electronic claim and 27 days to process a paper claim. Check  the filing date on your original claim before resubmitting.
Don't	Bill Medicare for routine physical exams and related services. Medicare does not pay for these services. These charges should be collected from  the patient. A signed waiver is not required.
Don't	Write "signature on file" for Item 31 (Signature of Physician or Supplier) of the CMS form 1500 for paper claims. It is appropriate to use "signature on  file" and/or a computer-generated signature for electronic claims.

AMA Is Reseller of Cloud-Based Medical Software

May 18, 2011 — The American Medical Association (AMA) has gone into the business of helping physicians go paperless, and qualify for federal cash in the process.

At a Web portal operated by an AMA subsidiary called Amagine, physicians can access software for electronic health records (EHRs), e-prescribing, patient registries, and more, all with a single sign-on, as opposed to a separate user ID and password for each program. As part of the deal, consultants will help customers select and implement the programs. The AMA calls it a 1-stop shop for gearing up to earn as much as $44,000 under Medicare, and almost $64,000 under Medicaid, for "meaningful use" of an EHR.

The Amagine Web portal, built with the help of a company called Covisint, debuted nationally last month after a pilot program among Michigan physicians. It epitomizes "cloud computing," or reliance on Internet-based programs that spare users the hassle and cost of hosting the software on an office-based computer, and keeping the programs updated to boot.

As with other examples of cloud medical software, programs available at Amagine come with no big upfront cost. Instead, physicians can essentially lease them from Amagine, which functions as a reseller. Customers sign up for a minimum 12-month contract and pay a monthly subscription fee, with AMA members receiving a discount ranging from 7.5% to 10%, depending on the product. Amagine advertises that a $300 monthly payment will put someone behind the wheel of an EHR.

Several healthcare information technology (IT) consultants interviewed by Medscape Medical News give Amagine mixed reviews. Although 1 consultant said Amagine may simplify a physician's transition to digital medicine, 2 others questioned the choice of some of the 20 programs on its menu of options.

"Dashboard" Composite of Patient Data

Physicians can choose a mix of programs 1 from 5 categories:

• EHR: Three programs are available, from NextGen Healthcare, Quest Diagnostics, and Ingenix, a business owned by UnitedHealth Group that is changing its name to OptumInsight.


• E-prescribing: The offerings here are Rcopia from Dr. First, CareLab360 Labs and Meds from Quest Diagnostics, and Amagine ePrescribing, said to be "powered" by Allscripts, an electronic prescribing and EHR vendor.


• Revenue cycle management: Infinedi, NaviNet, and AMA PATH provide tools allowing physicians to conduct online insurance verification, transmit claims electronically, estimate a patient's financial responsibility at the point of service, and automate other billing functions.


• Quality reporting and patient registries: Physicians who want to earn "meaningful use" bonuses must report to the Centers for Medicare and Medicaid Services how they manage preventive and chronic illness care for various patient subgroups. Three patient registries called DocSite, WellCentive, and Rcopia-MU help physicians do this.


• Lab ordering and results: The single program in this category — Care360 Labs — allows physicians to submit lab orders and review results online.


• Clinical support: Using the 7 programs in this category, physicians can look up drug interactions, journal articles, and evidence-based diagnostic and treatment advice; order medication samples online; and communicate online with patients.

The Amagine Web portal aggregates a particular patient's data from a chosen suite of these products into a single "dashboard" view. Certain bundles of programs are designed to be interoperable, meaning they can exchange patient information, said Robert Musacchio, PhD, senior vice president of business product solutions at Amagine. Dr. Musacchio told Medscape Medical News that if a physician selects products that lack this kind of data interface, Amagine will create one free of charge, as long as it is a "standard integration."

AMA Receives Commission as Reseller

Amagine states that it gives physicians — confronted with hundreds of medical software products — a pared-down list of carefully vetted vendors that meet its standards for integrity, reliability, security, and user satisfaction. Among other things, the vendors must demonstrate financial stability and focus on office-based medicine, as opposed to inpatient care.

The line-up of vendors, especially those in the EHR category, does not impress healthcare IT consultant Mark Anderson in Montgomery, Texas. "The medical associations I work with don't recommend any of these products," Anderson told Medscape Medical News.

Prominent EHRs that do not appear in the Amagine stable include some that regularly earn number 1 rankings in customer satisfaction surveys conducted by a research firm called KLAS. The latest KLAS ranking by practice size puts the following products in the top spot:

• 2 to 5 physicians: e-MDs Chart from e-MDs;


• 6 to 25 physicians: Greenway Medical PrimeSUITE Chart from Greenway;


• 26 to 100 physicians: eClinicalWorks EMR from eClinicalWorks; and


• more than 100 physicians: EpicCare EMR from Epic.

Anderson said the EHRs offered through Amagine have their good points but suggested that financial considerations may have weighed heavily in their selection. He noted that some organizations have endorsed EHR products because vendors were willing to "pay to play" — that is, simply buy an endorsement. Healthcare IT consultant Barb Drury in Larkspur, Colorado, voices similar concerns. "There has to be a business reason [for both sides]," Drury said.

Dr. Musacchio said Amagine is not a pay-for-play marketing venture. "[Vendors] don't pay us to be on the site," he said. One financial consideration that does affect vendor selection, he noted, is the commission that Amagine earns for reselling subscriptions to online programs. If a company proposed too low of a commission, "it wouldn't be economical for us to sell its product on the portal," he said.

Dr. Musacchio said Amagine would be adding more products to its line-up. He noted that some prominent EHR vendors initially did not meet the technological criteria set by his company. "Since then, things have evolved," he said. "Now that some of the technological issues have been worked out, you'll see more products come aboard in the future."

At the same time, said Dr. Musacchio, Amagine cannot do business with everyone, nor should it attempt to. "We want to give physicians a choice, but we're not aiming for an infinite number of choices," he said. "Otherwise, that would paralyze a physician's decision-making."

"Trusted Source" vs Typical Vendor

Rosemarie Nelson, a healthcare IT consultant in Jamestown, New York, who is affiliated with the Medical Group Management Association, also sees a benefit in a limited field of products.

"What Amagine is saying is, 'We're going to simplify the deal,' " Nelson told Medscape Medical News. "It would appeal to a lot of practices that are overwhelmed with the decision points."

Nelson said that practices unsure about selecting and implementing the technology could benefit from Amagine's consulting services as well. Those consultants, according to Dr. Musacchio, represent a combination of Amagine staff and third-party companies that provide a regional presence.

Amagine's consulting arm reinforces the company's role as a technology reseller. Customers do not have a direct relationship with any of the software vendors whose products are on the Amagine platform. "They have a relationship with us," said Dr. Musacchio. As a consequence, if they experience a problem with their software, they would turn to Amagine for assistance.

Nelson said Amagine may win customers as a "trusted source," because of its AMA roots. However, Barb Drury advises physicians to keep up their guard and treat Amagine as they would any other vendor. She recommends that they study the terms of use and related business documents at the company Web site, found by clicking on the "Legal" link at the bottom of the page.

Medicare EHR Incentive Payments to Be Issued

The First Medicare Electronic Health Record (EHR) Incentive Payments Will Be Issued This Week
The Centers for Medicare & Medicaid Services (CMS) is pleased to announce that incentive payments for the Medicare EHR Incentive Program will be sent out this week! Providers who have successfully attested to having met meaningful use, and who have met all the other program requirements, can expect to receive their 2011 incentive payments soon.

What Kind of Payment Can I Expect?
Eligible Professionals (EPs) participating in the Medicare EHR Incentive Program receive a payment based on 75 percent of their total Medicare allowed charges submitted no later than two months after the end of the 2011 calendar year. The maximum allowed charges used for a 2011 incentive payment is $24,000.  This means that the maximum incentive payment an EP can receive for the first participation year is $18,000.

Please note that incentive payments will not be made to an EP until the EP meets the $24,000 threshold in allowed Medicare charges.

Incentive payments to eligible hospitals and critical access hospitals are based on a number of factors, beginning with a $2 million base payment.

How Are Payments Made?
Participants will receive their Medicare EHR Incentive Program payment the same way they receive payments for Medicare services, via electronic funds transfer or by paper check.  Payments to Medicare providers will be made to the taxpayer identification number (TIN) selected during registration for the Medicare EHR Incentive Program.  For electronic transfers, CMS will deposit incentive payments in the first bank account on file and it will appear on the bank statement as "EHR Incentive Payment."

IMPORTANT: Medicare Administrative Contractors (MACs), carriers, and fiscal intermediaries will not be making these payments. CMS is working with a Payment File Development Contractor to make these payments. Please do not contact your MAC regarding EHR incentive payments.

Medicaid EHR Incentive Program Payments
Since January 2011, several states that started their Medicaid EHR Incentive Programs have made payments to many EPs and eligible hospitals who have met the requirements for the Medicaid EHR Incentive Program. To date, over $83 million in Medicaid incentive payments have been issued to EPs and eligible hospitals participating in the EHR Incentive Program.

To view a checklist of how to participate in the Medicare or Medicaid EHR Incentive Program, look at the Path to Payment section of the EHR website.

Want More Information About the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.

Radiology Billing - How to Submit Claims to Insurance

The examples in this section are to help providers bill radiology procedures on the CMS-1500 claim form.  Refer to the Radiology:  Diagnostic section of this manual for detailed policy information.  Refer to the CMS-1500 Completion section of this manual for instructions to complete claim fields not explained in the following example.  For additional claim preparation information, refer to the Forms:  Legibility and Completion Standards section of this manual.

Billing Tips:     When completing claims, do not enter the decimal points in ICD-9-CM codes or dollar amounts.  If requested information does not fit neatly in the Reserved for Local Use field (Box 19) of the claim, type it on an 8½ x 11-inch sheet of paper and attach it to the claim.

Chest X-ray                                  Figure 1.  Chest X-ray.

This is an example only.  Please adapt to your billing situation.

In this example, CPT-4 code 71020 (radiologic examination, chest; two views, frontal and lateral) is billed with modifier ZS (indicating both professional and technical components were provided) in the Procedures, Services or Supplies field (Box 24D).

In the Date(s) of Service field (Box 24A), the date of the office visit, June 7, 2007 is entered on claim line 1 as 060707.  Enter Place of Service code 11 (office) in Box 24B.

Enter the referring provider name in the Name of Referring Provider or Other Source field (Box 17) and the referring provider’s NPI in
Box 17B.  Enter the rendering provider’s information in Service Facility Location Information field (Box 32) and the NPI in Box 32A.

Enter the usual and customary charges in the Charges field
(Box 24F).  Enter a 1 in the Days or Units field (Box 24G) for code 71020.

Bilateral Radiography Billed         Figure 2.  Bilateral radiography billed with unilateral code.

with Unilateral Codes

This is an example only.  Please adapt to your billing situation.

In this case a physician orders a bilateral eye socket X-ray.  This claim example illustrates the billing of a bilateral radiographic procedure with a unilateral code.

In the Reserved for Local Use field (Box 19), enter a statement declaring a bilateral procedure was done but was billed with a unilateral code.

In this example, CPT-4 code 70190 (radiologic examination; optic foramina) is billed with modifier TC (technical component) in the Procedures, Services or Supplies field (Box 24D).

In the Date(s) of Service field (Box 24A), the date of the office visit, June 7, 2007 is entered on claim line 1 as 060707.  Enter Place of Service code 11 (office) in Box 24B.

Enter the referring provider name in the Name of Referring Provider or Other Source field (Box 17) and the referring provider’s NPI in
Box 17B.  Enter the rendering provider’s information in Service Facility Location Information field (Box 32) and the NPI in Box 32A.

Enter the usual and customary charges in the Charges field
(Box 24F).  Enter a 2 in the Days or Units field (Box 24G) for code 70190.  This number indicates the procedure is bilateral. Enter in the Reserved for Local Use field (Box 19) that the procedure was performed bilaterally.

For more details; send us your questions at help@healthinformatrix.com 

New Attestation Resources Have Been Posted

CMS has developed attestation worksheets to help providers successfully attest to meeting meaningful use through the CMS web-based attestation system.

These attestation worksheets allow eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) to log additional data for core and menu measures that might not be obtained only through their certified electronic health record (EHR) system. In order to provide complete and accurate information for certain of these measures, EPs and hospitals may have to include information from paper-based patient records or from other areas. (Please note that clinical quality measures must be reported directly from certified EHR technology).

You can fill out the attestation worksheets electronically or manually, and then keep the worksheet on hand as you attest so your data is easily accessible.

You can find the worksheets by clicking the links below. Make sure to use the worksheet that pertains to you:

• 
  
  Attestation Worksheet for Eligible Professionals


• 
  
  Attestation Worksheet for Eligible Hospitals and Critical Access Hospitals

Updates to the Comprehensive EHR Incentive Program FAQs Document
CMS has also posted the latest FAQs document on the CMS website. This interactive document provides updated FAQs up to the end of April 2011. Each FAQ is sorted by topic to help you more easily review information about various aspects of the EHR Incentive Programs. CMS will continue to provide updates as new FAQs are added.

Want more information about the EHR Incentive Programs?
Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs

Group Practice Association Leery of ACO Rules

May 12, 2011 — An association representing the nation's largest multispecialty medical groups is telling the Obama administration to simplify proposed rules for accountable care organizations (ACOs) if it expects physicians to sign up for them.

Created by the new healthcare reform law, ACOs bring together physicians, hospitals, and other providers in various combinations for the purpose of coordinating the care of Medicare patients who otherwise might fall through the clinical cracks and run up a higher bill as a result. Beginning in 2012, ACOs can share in any savings they produce for Medicare, provided they also meet certain quality-of-care standards. The bonus would come on top of their usual fee-for-service revenue.

The Centers for Medicare and Medicaid Services (CMS) touts ACOs as a way to reward providers for the quality of their patient care, as opposed to the quantity of services rendered. First, however, it must persuade physician groups to sign up, which may be a hard sell. In a letter sent yesterday to CMS Administrator Donald Berwick, MD, the leader of the American Medical Group Association (AMGA) said that 93% of its members would not enroll in an ACO under proposed regulations that CMS released March 31.

"On its face, [the proposed rule] is overly prescriptive, operationally burdensome, and the incentives are too difficult to achieve to make this voluntary program attractive," wrote AMGA President and Chief Executive Officer Donald Fisher, PhD. His association represents large medical groups such as the Mayo Clinic and integrated healthcare delivery systems, in which more than 113,000 physicians practice.

Dr. Fisher said AMGA members find fault in particular with the formula for splitting Medicare savings with providers, the requirement for risk-sharing that exposes providers to financial losses, and quality measurement requirements. As it stands now, ACOs would have to meet 65 different quality standards to receive any bonus.

For example, at least 50% of primary care providers must demonstrate "meaningful use" of electronic health record (EHR) systems by the start of the second year of a 3-year "shared savings" program. The expression "meaningful use" comes from the economic stimulus legislation of 2009 that promises incentive payments under Medicare and Medicaid to providers if they deploy EHRs in ways that improve patient care while cutting costs.

Leaders in organized medicine worry that small physician practices may lack the resources — such as sophisticated EHRs — needed to jump through ACO hoops. The medical groups in the AMGA are arguably the most sophisticated, computerized, and well-heeled of all, and the fact that even they find the ACO too complicated to participate in is telling. Dr. Fisher hinted as much when he wrote, "As you know, most policy experts believe multi-specialty medical groups are best poised to become ACOs in the short term." Then he dropped the bombshell that the vast majority of his members view ACOs as unattractive.

The AMGA promised to submit a more detailed critique of the proposed ACO regulations during the official comment period, which runs through June 6. Other provider associations are filing responses as well, all in the hopes of reducing the hassle factor. CMS is expected to release a final version of its regulations this summer. More information about ACOs is available on the federal Web site HealthCare.gov.

Advantages of Electronic Medical Records

By Shrinivas Kanade

Do you think 24 hour accessibility to your patients’ data is one of the advantages of electronic medical records? Yes! To know more about the advantages of electronic medical records,

Read on…

One of the main advantages of electronic medical records is that it helps in centralizing the data of your patient. Not long in the past, a receptionist working in a clinical practice could leave for the day, only after finding and arranging the records, that are committed to the papers of the patients on the next day’s appointments’ list. If she failed to do so, or if she failed to turn up on time due to some kind of emergency, then what would rule the medical practice.

Confusion! She is the one who knew, precisely, which stack of records contains the bunch of papers that represents so and so patient. The use of electronic medical records gets over this problem. Let’s go over the other electronic medical records benefits.

What are the Advantages of Electronic Medical Records?

In its digital form, the electronic medical records offer you an opportunity to run a clean and paperless clinic. If you decide to go digital, you may find that there are two options available to you.

Standalone Software

The first option is to ask a computer programmer to develop a standalone software for you, which you could install in the computer in your office. In this case, your patients’ data, in its electronic form, will be stored on the computer system in your office. You will have to take care of the data. The data safety, proper backing of the data to protect it from getting lost and virus problems will be the responsibility of your clinic, since the data is present at your end.

Online Software

Else, you could use an online EMR software. If you choose this option, your patients’ data will be stored on the Internet. It will be stored in the computers maintained by the IT company which is providing their online software to you, naturally for a monthly fee. This IT company and the computer experts employed by it, will take care of the data and deal with your problems while using it.

Electronic Medical Records

Electronic medical records, which are also referred to as EMR, contains private and medical data related to your patients. It may also contain information, such as their past medical history, substances or drugs they are allergic to, the treatments or medical procedures they underwent in the past. The data may also inform you which medications the patient is currently on and the transcription notes etc. Comprehensiveness in the patients’ data is one of the advantages of electronic medical records.

Speed of Retrieval of Electronic Medical Records

You can retrieve your patient’s records within a few seconds. All you have to do, is to type his or her name in the form that the EMR software has presented to you. Bingo! the records are right in front of you within no time. And the most important thing is that you are not struggling to decipher someone else’s handwriting, in order to read what kind of therapy or treatment your patient underwent in the past. The availability of your patient’s medical records in one place, which can be viewed in detail, is also one of the advantages of electronic medical records.

If you decide to go for online EMR software, you will find that you can access your patient’s data not only by sitting at your office but from anywhere in the world through the Internet. Of course, you must provide it with proper passwords and identify yourself. You can download electronic medical records to your PDA or palmtop and can refer to it as and when it suits you.

Safety

Your patient’s data is important and you have every right to worry about it. Will it be safe in its digital format? Yes, it will be. You must have heard about the computer system crashes and the computer viruses causing damage to the data. These may have made you suspicious about the reliability and safety of the electronic medical records. With proper backup systems and latest anti-virus, you can overcome this obstacle.

Data Format

When you use papers to commit your patients records on it, you do so in the fixed format. The format that is printed on the paper. It is not the case with the electronic medical records. You can key in data in one format and can retrieve it in another, in a form more suitable to you.

Integration and EMR Software

You can digital form of your patients data to the reference information which can be stored on your computer or on the Internet. The EMR software can help you by providing additional information about a drug, such as dosages for children and adults. Which drugs are contraindicated in which conditions and so on. The EMR software can not only help you out with your patient’s data but it can also provide information on the ICD.9, HIPAA, HCFA 1500, and the latest CPT code books. It may also help you in studying a condition by producing a 3-D images for you, by taking input of 2-D images that are already present in your patient’s data. The software also handles the medical transcription notes, as well as SOAP notes, which you can use to your own advantage. The customer support to medical billing services can also be made available to you and your patient by the EMR software. This may result in the speedy settlement of medical billing and claims for you because of the proper co-ordination with the insurance companies over medical insurance. In short, the ability of EMR software helps you centralize your resources can be counted as one of the advantages of electronic medical records.

Electronic Data and EMR Software

Electronic data generated by the systems monitoring your patient, is processed and analyzed for errors by the the EMR software. This software can sound or raise an alert, if it comes across an event needing immediate medical intervention. It can transmit the relevant data in the form of an email or warn you by sending a message to your pager or mobile. It can also accept data from the laboratory analyzer in a electronic form directly and thus, avoiding the chance of erroneous data being fed to it by a computer operator. In case of online EMR software, which you will use the database to store your patients’ data in, and support to it will be provided by the IT company.

Primarily, it is you who is going to benefit by converting to electronic medical records. It will help your staff to be more efficient by saving their time. Your patients’ data in its digital form will always be at your fingertips and not be dependent on the mindless activity of searching for it every day. It seems that the benefits of an electronic medical record (EMR) are nothing but a bag of goodies. But, are they real for you? The decision is yours. With the world going digital, it is up to you to decide, whether to take heed of the advantages of electronic medical records.

Above article published on http://www.buzzle.com/articles/advantages-of-electronic-medical-records.html

CMS Removes Credentialing Barrier to Telemedicine

May 3, 2011 — New regulations issued yesterday by the Centers for Medicare and Medicaid Services (CMS) remove a barrier to telemedicine that had nothing to do with computer technology.

The problem, CMS said, was its own old regulations on how hospitals should vet physicians who are hundreds or thousands of miles away, yet practice medicine within their walls by virtue of digital technology.

If an oncologist on the medical staff of a big city hospital, for example, sits down with a Medicare or Medicaid patient at a rural hospital via teleconference, the rural hospital also needs to grant him or her staff privileges to stay in the good graces of CMS. In the past, CMS required the hospital on the receiving end of telemedicine to follow the same credentialing procedures with remote physicians as it did with local ones. That meant relying on the recommendation of its medical staff, which has the duty of appraising candidates for practice privileges and verifying their credentials.

However, CMS recently concluded that this requirement was not only duplicative but also burdensome on small hospitals that might lack the resources to vet physicians practicing telemedicine. The agency noted in its new regulations on the subject that small hospitals often lack in-house medical staff who have the clinical expertise to "adequately evaluate and privilege the wide range of specialty physicians that larger hospitals can provide through telemedicine services."

Acknowledging that its requirements might make it harder for small hospitals to take advantage of telemedicine, CMS has opted for a simpler approach. Under the new regulations, a hospital still must grant practice privileges to a telemedicine physician based on the recommendation of its medical staff. However, the medical staff can dispense with its own fact-finding and instead rely on the credentialing and privileging decisions of the distant hospital where the physician in question practices.

In a press release issued yesterday, CMS Administrator Donald Berwick, MD, stated that his agency wants to "devise policies that reflect the most innovative practices in delivering care to all patients, especially patients in rural or remote parts of the country through telemedicine."

More information on the new CMS regulations is available on the agency's Web site.