RSSRecent Articles

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
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!

ECFMG calls out a ‘certification’ organization

disclosureThe Educational Commission for Foreign Medical Graduates (ECFMG) is cautioning international medical graduates (IMGs) about organizations that represent themselves as having a role in certifying the qualifications of IMGs to enter U.S. residency and fellowship programs.

ECFMG issued a statement yesterday about the American Medical Residency Certification Board (AMRCB), which “professes to receive its educational authority from an entity named the New England Consortium on International Medical Education,” according to ECFMG.

“The AMRCB website states that it provides ‘certification’ for international medical schools and for international medical students and graduates, primarily through one-day seminars … AMRCB goes on to represent that although AMRCB certification is not currently mandated, it is expected to be ‘required of all international graduates in the future.’ To the contrary, AMRCB ‘certification’ has no official standing with the medical licensing authorities in the United States, nor is such a requirement being considered,” the ECFMG stated.

ECFMG certification is required for IMGs seeking to enter ACGME-accredited residency and fellowship programs in the U.S. ECFMG certification is also required before IMGs may apply for Step 3 of the United States Medical Licensing Examination. “No other certifications are currently required for IMGs’ eligibility to apply for residency and fellowship programs accredited by ACGME or for unrestricted medical licensure in the United States,” the statement reads.


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!

Monday memo: Check out the newest issue of CRCJ

TIPThe newest issue of the Credentialing Resource Center Journal has been posted on the CRC website, and includes the first installment of our look at credentialing practitioners in hospital-owned clinics. This was the topic of a recent Credentialing Resource Center Insider Editor’s Note that generated a high level and variety of responses, despite hitting inboxes on a Friday in the middle of the summer. Thank you to all who have contributed insight or just curiosity to this challenge! This is a topic that will be revisited.

Another highlight in the new edition is Rosemary Dragon’s prescription for a successful pre-survey boot camp for physicians and medical staff leadership. (Don’t spare the chocolate.)

Thanks for reading!

Driving a ‘Compact’ for speedier physician licensing

The Federation of State Medical Boards (FSMB) has completed the drafting process for its model legislation to create an Interstate Medical Licensure Compact. State legislatures and medical boards can consider adopting the model legislation to establish a compact that would expedite the licensing process for physicians who wish to practice in multiple states.

The model establishes the location of the patient as the jurisdiction for oversight and patient protections. Participation in the compact would be voluntary for both states and physicians, and member states would maintain control “through a coordinated legislative and administrative process,” according to an FSMB press release.

The Interstate Medical Licensure Compact could significantly reduce barriers to the process of gaining licensure in multiple states, and would help facilitate licensure portability and telemedicine, particularly in underserved areas of the nation, the FSMB states.

You can see the Interstate Medical Licensure Compact model legislation here.

What do you think? Would an interstate medical compact expedite credentialing and privileging processes as well? You can let me know at

Thank you for reading!


Tune in on Thursday

admin01_11184880When CMS seems to want one thing and accreditors want something else, you need to cut through the confusion. Fortunately, there’s still time to join us for Verify and Comply: Meet Your Top Credentialing Challenges! Tune in on Thursday, September 4, from 1:00 to 2:30 p.m. Eastern Time for this 90-minute webcast. Carol S. Cairns, CPMSM, CPCS, will help clarify the differences among CMS and accreditors, and their expectations for medical staffs. In addition to specific requirements, best practices in credentials verification will be highlighted.

We will also identify and solve several common problematic credentialing standards that can plague your organization.

After this program, participants will be able to:

  • Describe credentialing best practices
  • Identify the similarities and differences among regulators and accreditors (including CMS, The Joint Commission, DNV, HFAP, and NCQA)
  • Differentiate current requirements from old medical staff standards language and “urban legends”
  • Clarify vague standards and unclear terminology
  • Know what must be done to ensure compliance, what is actually being done, and how to do it better

Click here to learn more about this webcast.