good day everyone my name is Ethan moderate versus baby now welcome everyone for today's webinar telemedics in CMS and TJC standard I would like to introduce our presenter for today darling even darling even Amazon RN cpaq is a nurse consultant for Nash Healthcare Consulting darling brings 25 years of experience in the healthcare industry specializing a clinical and Regulatory operation management and accreditation Readiness and response I would now like to hand over the flow to the one of the best speaker of Nash Healthcare darling Evans thank you so much and thank you for joining us so thank you especially for taking your time out to be with us in Nash Healthcare as we present the information on telemedicine CMS and The Joint Commission standards relative to telemedicine we have a lot of information to share and as always Nash Consulting offers you many embedded resources and other slides for your referral and reading opportunities Beyond this particular presentation also we are available to you for any needs that you may have otherwise so without further Ado we'll get started so with that we certainly if you had not had any familiarity or any type of telemedicine Telehealth or Radiology type process service within your organization or in collaboration with a distance site then certainly during covid many organizations face that opportunity a positive one we might add so that was really the Crux in the portion of the overview as a result of the pandemic and that it quickly propelled us into these discussions if you are on the call on one of those organizations or if you're uncertain whether you are one of those organizations that didn't have prior services and was granted a waiver that waiver was called the 1135 waiver and it specifically about the capability of providing these Services through various means and to include Medicare patients and Service Pro revisions so as always as I said we provide you with a number of resources and information that you can refer to following this session so please do so so here you'll see again some various links and dot gov sites that are available to you for the addressment of that so the functional aspect or I'll say operational aspects of the waiver and the process for that also allow the provision of audio and video equipment permitting two-way real-time interaction so later on you might hear the term synchronous or asynchronous that synchronous aspect of communication allows that two-way Communication in real time again from one site to another or with one person to another in their setting all right contract with entity for telemedicine and again generally there is some type of contractual agreement a lot of advantages as I said not only for that acute response for patients that certainly felt they may have been exposed to or actually contracted covid but also other care delivery means as well so it had significant advantages for those organizations who had not really had those services or had a comfort level with those services or the communities and patients with them so this is a CMS document that is just again filled with a tremendous amount of resource information about the processes and it's called Medicare Learning Network and it does go over the billing aspects or other service aspects for telemedicine and Telehealth so you know again there was reimbursements under the waiver because of those emergency response needs that we had across the country but also then there's still that payment and possibility of again a financial viability for the use of such service so the standards and guidelines are pretty clear and they are continuing to be addressed so there are some comments and guides relative to Mental Health Services rehab um we'll say the eicu type video conferencing and those kind of things like that so some of the practice guidelines that are out there now as I said they've either been an evolution or certainly have been just propelled as a result of covet and everything we're learning is is just some of those and the resources are tremendous about these service line capabilities then there's the American Medical Association telemedicine resources and and certainly there's again a extended amount of references here for um the use within your organization and again they've been in place for years and they continue to evolve part of this came from as I said is far back as in the 90s and certainly in the late 90s where it was just far more appropriate to start developing some of these processes so 2014 approved guidelines to help address that and then those model policies that have to be in place and then those references to the contractual agreements and again all going back to what are the roles and responsibilities of primary site in the distance site I.E Hospital clinic individuals entity group how the oversight for monitoring the appropriateness of the Care delivery what is the satisfaction how's it going to be annually reviewed and ultimately that the medical staff and board and Leadership of those entities really have the responsibility for the odor ownership of that care delivery process Federation of State Medical boards began to identify again the requirements again that primary sites or distance sites and how and under what circumstances the use of that would be reimbursed then you get to some specific standards so if you um certainly all organizations that provide care can be under the conditions of participation but if you are also duly acknowledged so in this case accredited by The Joint Commission or other like entities they will have regulations around telemedicine and tele Services as well well okay but foremost absolutely the credentialing and privileging process or the accountability for having providers and clinicians working within the scope of their practice within the states that govern their service and licensure will be imperative and absolutely will be looked at so o4 0309 EP 23 again talks about that originating site and again it's through that agreement so they'll quite often pull those contracts and look they'll look to see when they were approved the time expiration dates the manner in which Clinical Services were evaluated how that is integrated into the body of the hospital for performance Improvement so um again just saying this in a different way distant site hospital or distance site telemedicine entity it might be a service it might be a clinic it might be something else so again knowing the vernacular and what we're talking about as it relates to your organization I'll I'll say and then that distance site organization and then the Federal Register again that goes back to your conditions of participation if you really have an oversight or even another entity like your third party credential verification organizations or your cbo's that everybody understands what their roles and responsibilities are making sure again that you look and again with any type of care you want to also read those inteller regulations for again how it applies to you what types of I'll say instruction and services can be provided in under what circumstances so I mentioned to you um so there's telemedicine and Telehealth how we look at that and the clarity of that word usage we talked about simultaneous and non-simultaneous and then I'll pause here going back to who's all involved so if you've offered various types of services so whether it's Podiatry or assessments for Dermatology or it is covered follow-up or monitoring versus care delivery different types of things like that who's doing that who's involved in that what's their roles and responsibility does their scope of practice and law and regulation support that with that again thank you for your participation today thanks darling that was wonderful every night it was a very detailed and resourceful and that does conclude the session for today you may all disconnect now you all have a great day ahead