Verify and Comply


Book Description




The Credentialing Handbook


Book Description

The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more.







The Handbook for Credentialing Healthcare Providers


Book Description

This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff and to understand why you must! Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also undergirds the reputation and credibility of the institution in the eyes of providers and across the healthcare community. Further, credentialing with insurers forms the basis for reimbursement for professional services. Without the acceptance of the professional credentials of a provider, insurers and other third-party payers will not compensate his or her claims. The purpose of this book is to explain the necessity and to provide the process for the official documentation of each practitioner. The information presented in these chapters will serve as a practical resource for strengthening your organization's credentialing function. = Book Features! -Outlines the necessity for credentialing in the delivery of care and in attaining reimbursements for services provided -Explores options for in-house and outsourced credentialing function -Provides systematic process for ongoing credentialing operations




The Medical Staff Leader's Survival Guide


Book Description

The Medical Staff Leader''s Survival Guide William K. Cors, MD, MMM, FACPE An affordable, time-sensitive solution to medical staff leadership training. Physicians who accept or are assigned leadership positions are often left on their own to develop leadership skills and educate themselves about their responsibilities as medical staff leaders. Just because a physician is a great clinician does not mean he or she is a great leader. The challenges of being a successful medical staff leader are twofold: You must be well-versed in your role and responsibilities (i.e., peer review, credentialing, medical staff bylaws), and you must inspire other medical staff members to follow the rules while continuing to deliver excellent patient care. A well-trained medical staff leader is vital to the culture of a hospital''s medical staff and can save a hospital from the expense of lawsuits affiliated with negligent credentialing/peer review. This book aims to teach physicians how to become great medical staff leaders and how to motivate other medical staff members on topics such as: AHP credentialing and supervision Reappointment challenges Physician-hospital competition Liability risks Medical staff disharmony and distrust Table of Contents Chapter 1: Where to Begin? Principles of Governance Chapter 2: Meetings: The Cost of Holding a Meeting Chapter 3: Meetings: How to Run an Effective Meeting Chapter 4: Overcoming Physician Apathy Chapter 5: Job Descriptions: Medical Staff Leaders Chapter 6: The VPMA/CMO: Where This Fits Chapter 7: Credentialing and Privileging: Requirements, Guidelines and Tips Chapter 8: New Technology Privileges Chapter 9: Privileging Disputes and How to Resolve Them Chapter 10: Advanced Practice Professionals Chapter 11: Low-Volume, No-Volume Practitioners Chapter 12: The Aging Physician Chapter 13: Proctoring (FPPE) Chapter 14: Peer Review (OPPE): Some Best Practices Chapter 15: Dealing with the Physician with Problems Chapter 16: Corrective Action: The Good, the Bad and the Ugly Chapter 17: Physicians and Hospital Administration: They''re Just Different Chapter 18: EMTALA and Emergency Department Coverage Chapter 19: Conflicts of Interest Chapter 20: Economic Credentialing Chapter 21: Physician-Nursing Relationships Chapter 22: Health Care Finance: A Primer Chapter 23: Medical Errors Disclosure Chapter 24: Employed Practitioners Chapter 25: Contracted Practitioners Chapter 26: Confidentiality Chapter 27: Accreditation and Regulation Chapter 28: Bylaws and Related Documents Chapter 29: Medical Staff Governance: Myths and Misconceptions Chapter 30: Personal Characteristics of Great Leaders Who will benefit from this book? Directors of medical staff offices, vice presidents of medical affairs, medical staff presidents, credentials committee chairs and members, committee and department chairs




The Credentialing and Privileging Toolbox


Book Description

MSPs and medical staff leaders do enough vetting for practitioner applications without worrying about tracking down and validating resources that support structurally sound credentialing and privileging processes. Featuring an array of field-sourced, expert-endorsed forms that facilitate regulatory compliance, policy development, and routine credentialing communications, The Credentialing and Privileging Toolbox lightens the administrative load so MSPs and medical staff leaders have more time for duties that foster high-quality care and patient safety. Inspired by our popular OPPE and FPPE toolboxes, The Credentialing and Privileging Toolbox offers a bevy of sample forms, policies, letters, plans, reports, and related resources that healthcare organizations of various scope, size, and service focus are currently using to execute effective practitioner vetting processes. Included tools, which come from in-the-trenches MSPs and medical staff leaders, have been curated and appraised by expert author Merella Schandl. The resulting collection reflects industry best practices, the wide range of modern healthcare entities that credential and privilege practitioners, and the various aspects of a successful vetting approach. Tools are arranged by type and topic for easy navigation. Within each tool, Schandl highlights key components and provides targeted analysis on tailoring the sample to individual facility needs.




The Credentials Committee Manual


Book Description

Best practices for compiling and using data in reappointment decisions, navigating credentialing considerations for nonphysician practitioners, preventing turf battles, and avoiding legal issues




The Medical Staff Office Manual


Book Description

The Medical Staff Office Manual: Tools and Techniques for Success Marna Sorensen, CMPSM The Medical Staff Office Manual: Tools and Techniques for Success is a comprehensive guide that maps every aspect of the medical staff office, from onboarding and orienting physicians to querying other facilities for practitioner information and effectively collaborating with physician leadership. In this in-depth manual, author Marna Sorensen, CMPSM, provides MSPs guidance on their role within an organization, quick access to accreditation and regulatory information, and job descriptions and customizable forms to simplify a constantly growing list of daily responsibilities. This book will help you: Consolidate everything you need to do your job into one place Detail procedures for all of your daily tasks, including practitioner data queries, acceptance letters, job descriptions, performance reporting, and sample forms Demonstrate what you do on a daily basis and clearly define your many roles as an MSP--no more questioning who is responsible for what! Update medical staff office functions and get the word out using the new technologies at your disposal Table of Contents Introduction/How to Use This Manual Medical Staff Organization and Staffing Medical Staff Office Job Descriptions The Credentialing Process Medical Staff Clinical Privileges Advanced Practice Professionals Templates for Most-Used Forms Medical Staff Policies HR or MSO?




Credentialing a to Z


Book Description

Credentialing A to Z is an on-the-go reference packed with easy- to-digest information, Q&As, quizzes, notes, and downloadable forms that will help MSPs gain knowledge about their tasks and the value of their work, enhance team-building, and combat burnout and stress. Author Mary Long, CPMSM, brings in-depth insights, a light touch, and a sense of humor that fellow MSPs will appreciate. This valuable reference guide addresses, defines, and explains your toughest topics in alphabetical order, including: A: Applications-where all credentialing processes start, and possibly end. APPs-are advanced practice professionals processed through the medical staff services department or human resources? B: Bylaws, policies, and rules and regulations-do you know where your medical staff information is? C: Credentialing-the right information to verify, and the correct way to do it. G: Governance-an organized medical staff requires governance in order to function. But what does that have to do with credentialing? M: Meetings-medical staff management in "minutes." P: Peer evaluations, FPPE, and OPPE-who's a peer? Who's a good peer? Privileging-the whens and hows of core privileges, disaster privileges, emergency privileges, and temporary privileges of all stripes. R: Reappointment-building and sticking to a cycle. Red flags-spotting them, stopping them, and getting answers. V: Verification-the querying process, the organizations, and the information they provide. X, Y, and Z: Xenon, yag lasers, and zero data (mastering medical terminology-no, CABG isn't "cabbage") Credentialing A to Z provides new MSPs and credentialing coordinators on-the-job spot training that will build and test their knowledge in a fun way before they're put to the test with less-fun credentialing challenges (such as surveys). All quizzes, Q&As, and other forms are downloadable and customizable, allowing MSPs to tailor them to their programs.