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Helping physicians understand the credentialing process

Do you struggle with explaining/helping newly-minted physicians through the credentialing process? Does this sound familiar:

Although physicians who complete an ACGME-approved residency come out of that program trained to provide patient care within their specialty, they are not equipped to handle the major paperwork and administrative processes associated with application to the myriad healthcare organizations and healthcare plans to which they will apply. Although there may be administrative staff to help with completing these applications, the physician must initially provide the information to the support staff.

Physicians also need to know what the credentialing and privileging process entails and how they can best help with getting all the necessary documentation they need to go along with the application. The sooner a physician gets on staff at a hospital or on the panel of a health plan, the sooner he or she can begin generating revenue. Many times, the process is held up due to late applications or applications that lack sufficient information.

HCPro is working on a book and needs your help. Do you think a book describing the credentialing process to physicians would make your job easier? If so, what would you like to see included in this book? If you don’t want to respond in the comments, feel free to email me directly: kkondilis@hcpro.com

Thanks for your help!

Karen

Words to live by

news01I’ve been poring over my notes from the 2014 NAMSS Educational Conference and Exhibition, and discovered a quote from Hugh Greeley’s Tuesday presentation, “This is What We Live For: Effectively Dealing with Our Most Complex Applicants and Re-Applicants,” that stands out. Describing the MSPs’ role in protecting the patient, facilitating clinical practice, and supporting organizational improvement, Greeley said, “You don’t live for validating the licensure or processing the paperwork … you live to make it better.”

In a three-day span that offered so much MSP and medical staff leadership insight, and plenty of other words to live by, his statement resonated because it acknowledges the medical staff services department’s potential contributions to process improvement. The goal is to create and execute the best processes possible—but changes are often necessary, there’s always room for improvement, and MSPs are in a unique position to influence that improvement. Greeley also noted that it can be better to influence than to command.

If your medical staff leadership listens when you ask the questions that can move care forward at your organization, I’d like to know. And if you were at the NAMSS event this week, was there one educational session that stuck out for you? I’d be interested to know about that, too.

Thanks for reading!

Dateline New Orleans

OLYMPUS DIGITAL CAMERAIt’s been a busy couple of days at the NAMSS national contention, from Sunday night’s opening kickoff to the first day of sessions today. Here are some of the highlights:

Opening remarks by outgoing NAMSS President John Pastrano, BBA, CPCS, CPMSM, director, of medical staff services at Centennial Medical Center in Frisco, Texas, who noted that the 2014 event drew a record number of attendees, estimated at 1,500, and a virtual audience of nearly 600. In addition, NAMSS’ membership is on track to hit 5,200 this year, he said.

Keynote speech by David Nash, MD, dean of the Jefferson School of Population Health  in Philadelphia. Nash observed that medical staff services departments are the guardians of the gate of accountability and transparency. Changes in healthcare that emphasize transparency and accountability mean providers and systems are all going to be “naked,” in a figurative sense. And “if you’re naked, you’d better be buff,” he said.

The first copy of the latest edition of Verify and Comply, hot off the press and on display at the HCPro booth in the Exhibitor’s Hall. If you’ve ordered a copy of the new edition, it should be arriving shortly.  If you haven’t, click here for more information.

If you’re in New Orleans, take a minute to stop by the HCPro booth tomorrow, say hello, and see what we’re up to.

Thanks for reading!

See you in New Orleans!

NorleansIf you’re attending the NAMSS 38th Educational Conference and Exhibition next week in New Orleans, what are you looking forward to the most? Is it the keynotes? The sessions and panel discussions? Maybe the networking opportunities? The camaraderie of hundreds of people who know what you do and how challenging it can be? “All of the above?”

I hope to see you there, either during the presentations or in the exhibitors space. Stop by the HCPro booth and say hello. It’s been a busy year the Credentialing Resource Center and we’ll showcase some of our Credentialing and Medical Staff resources while we spread the word about what’s in store for 2015 … including the reinvigorated CRC Symposium in March!

Now it’s time for me to take care of some pre-travel details. But if there’s a do-not-miss item on your NAMSS New Orleans agenda, let me know.

Thanks for reading!

Verify and Comply meets Medical Staff Standards Crosswalk

Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth EditionVerify and Comply, Credentialing and Medical Staff Standards Crosswalk, Sixth Edition, combines both credentialing and medical staff standards and regulations into one easy-to-navigate manual, giving MSPs one book that answers all their accreditation questions. This expanded guide includes CMS, Joint Commission, NCQA, DNV, HFAP, and AAAHC standards side by side in an easy-to-read grid.

Subject matter experts Carol S. Cairns, CPMSM, CPCS, and Kathy Matzka, CPMSM, CPCS, have compiled a one-stop resource for answering your acute care, managed care, and ambulatory care medical staff/credentialing questions.

This side-by-side compilation of accreditors’ standards will help you:

  • Understand the differences between the stages of the credentialing process: appointment, reappointment, and ongoing assessment
  • Determine which verifications are necessary to obtain in the credentialing process
  • Assess ambulatory standards for your ambulatory facilities
  • Define the structure of your medical staff and its responsibilities
  • Determine the appropriate area in medical staff governance documentation to include specific items required by accreditation standards and regulatory requirements
  • Explain your medical staff’s involvement in organizational leadership functions

Click here for more information and thanks for reading!

The CRC Symposium is back!

25C7DBB7FDEE98EB339313F2B55B68D5[1]Dear readers,

Mark your calendars for March 12-13, 2015, for the return of the Credentialing Resource Center Symposium! The event will take place at Caesar’s Palace in Las Vegas. We have a great group of speakers lined up: Carol S. Cairns, CPMSM, CPCS; Hugh Greeley; Sally Pelletier, CPMSM, CPCS; and Todd Sagin, MD, JD.

In the weeks to come, keep your eyes open for more information about the symposium and interviews with the speakers appearing in the Credentialing Resource Center Insider and Medical Staff Leadership Insider e-zines, on this blog, and in the Credentialing Resource Center Journal and Medical Staff Briefing newsletters. For information about the symposium, click here. We hope you can join us next year in Las Vegas!

Stay tuned, and thanks for reading.

Are your medical staff bylaws showing their age?

Medical-LawIf your bylaws are silent on important issues, contain contradictory guidance, or suffer from years of obvious cutting and pasting, plan to tune in Wednesday, October 29, from 1:00 to 2:30 p.m. Eastern Time for help bringing these vital documents into the 21st century.

During a 90-minute webcast titled Medical Staff Governance: The Increasing Importance of Contemporary Bylaws, presenter Todd Sagin, MD, JD, will offer a roadmap for assessing bylaws and documents to determine if a simple update or complete overhaul is needed. Dr. Sagin will also discuss the steps to take that will allow medical staffs at any facility to create reasonable timetables for review and revision.

In addition to learning about the roles of MSPs, medical staff leadership, committee chairs and others in the bylaws review process, webcast attendees will be able to:

  • Address common hot-button issues that create liability
  • Apply best practices to the contents of contemporary medical staff bylaws
  • Prepare an effective approach to the review and revision of current medical staff governance documents

Ample time for Q&A will be provided for you to get your questions answered by Dr. Sagin, who frequently assists hospital boards, medical staffs, and physician organizations in their efforts to create or revise bylaws documents.

Click here to learn more about this webcast.

As always, thanks for reading!

 

Monday memo: Delegated credentialing and authorized agents

TIPHospitals are federally mandated to query the National Practitioner Data Bank (NPDB) when an eligible practitioner applies or reapplies for medical staff appointment or clinical privileges. “A hospital may not delegate its own responsibility to query or credential practitioners because of the federal requirement that hospitals must query. A hospital’s query must be submitted to the NPDB either directly by the hospital or through the hospital’s authorized agent,” the NPDB states.

The differences between delegated credentialing entities and authorized agents can be confusing, but in the September online issue of Data Bank News, the NPDB provides a side-by-side comparison/explanation (as well as the bolded text in each field):

Authorized agent

Delegated credentialing

An entity selects an authorized agent to report and/or query the NPDB on its behalf, without making credentialing decisions. The authorized agent simply performs the assigned tasks. An entity gives another entity the authority to
make final credentialing (i.e., hiring or privi-
leging) decisions, such as when a health plan
uses a hospital’s credentialing decision as the
basis for permitting a practitioner to partici-
pate in its network.
An entity that uses an authorized agent to report and/or query on its behalf still retains responsibility for making credentialing determinations for its practitioners. The entity that delegates credentialing is not
considered part of the credentialing process
and is prohibited from receiving NPDB query
results.
Hospitals may not delegate their responsibility to query because of the federal mandate for
hospitals to query the NPDB when a practitioner applies for a medical staff appointment or
clinical privileges and every two years thereafter. Health plans are the most common
delegators of credentialing, most often to hospitals.

Check out the NPDB page for more information about the differences between delegated credentialing entities and authorized agents.

And as always, thanks for reading!

Monday memo: Revisit privileging for ambulatory settings

TIPPhysician privileges have jumped from the medical staff services department to front-page news, as Becker’s ASC Review noted:

“An ear, nose and throat (ENT) specialist present in the New York City-based Yorkville Endoscopy operating room where Joan Rivers was undergoing an endoscopic procedure on her vocal cords did not have privileges to practice at that clinic, according to a report from The New York Times.”

The ENT physician examined Rivers both before and after the gastroenterologist performed an upper endoscopy, according to the report. Neither physician has been accused of wrongdoing by the New York State Department of Health.

National Public Radio subsequently aired a story that looked at privileging in outpatient surgical centers in general.

Although I usually prefer it when privileging stays out of the public eye, a higher degree of scrutiny might give more people outside the medical staff services department an inkling of why privileging and other MSP tasks are so important.

That’s my 2-cent tip for Monday. You can add yours here.

Thanks for reading!

 

‘Upcoding’ investigation snared physician and CEO

Medical-SymbolAre you looking for a short diversion from work? If so, consider the potential credentialing issues lurking in the following recent news story, in which fraud allegedly made house calls. There’s no test and no prize for the best answers.

According to the Chicago Division of the FBI, a physician and the CEO of Chicago-based Mobile Doctors, which manages physicians who make house calls in six states, were arrested late last month on federal healthcare fraud charges. Federal agents also executed search warrants at Mobile Doctors’ offices in Chicago, Detroit, and Indianapolis, along with warrants to seize more than $2.5 million in alleged fraud proceeds, the FBI reported.

The charges allege a scheme to fraudulently increase (also known as “upcoding”) Medicare bills for in-home patient visits that Mobile Doctors falsely claimed were longer and more complicated than they actually were. The charges also allege that Mobile Doctors’ physicians falsely certified that patients were confined to their homes, enabling home healthcare agencies to claim fees for additional services for patients who were not actually qualified to receive them.

The FBI and other law enforcement agencies executed the arrest, search, and seizure warrants in connection with the charges, as well as a broader ongoing investigation that includes allegedly illegal billing practices for medically unnecessary tests and services not performed by a physician, the FBI reported.

Thanks for reading!