Any MSP or medical staff leader who is currently involved in credentialing, privileging, peer review, or another important medical staff function is welcome to submit a case study proposal through our simple online application process. The winning case study will highlight a creative solution that the presenter(s) have helped implement at their organization. The chosen presenter(s) will win FREE admission to the CRC Symposium, among other prizes. Apply now! 

This week, CRC Daily covers credentialing—a critical function across the care continuum.

When it comes to delegated credentialing, communication is key. Strive to share information and be available for any questions or feedback. The ultimate goal is for partners to work together as a team to achieve the maximum benefits of delegation. The following are additional, more targeted recommendations for health plans and delegated entities, respectively.

In today's litigious healthcare climate, malpractice lawsuits can herald negligent credentialing claims that spell trouble for medical staff leaders and MSPs. Share the following tips with the practitioners on your staff to head off these legal sticky wickets.

“To provide meaningful information for patients, families, and caregivers about hospital quality, a star ratings system has to make sense.”

—Susan Xu, MPA, MS, and Atul Grover, MD, PhD, of the Association of American Medical Colleges, critique CMS’ Hospital Quality Star Ratings. 

Recredentialing is the process of reviewing or rechecking a physician’s information every two to three years. The process identifies changes in the physician’s training experience, current competence, or health status that might affect his or her ability to perform services for which he or she is contracted. This free resource is a sample request used to inform a physician he or she is due for recredentialing and what documents are required with an application.

When faced with a negligent credentialing claim, two priorities are paramount regarding documents in the hospital’s or healthcare entity’s possession.

There may be times when a hospital knows it’s not going to get a physician’s reappointment application processed before his or her privileges expire. This could be for any number of reasons, such as the physician just never got around to completing the application or the person in the medical staff office who processes applications has been out due to illness.

by Laurel J. Yungwirth, CPCS, MHA

About five years ago, my employer, Allegheny Health Network (AHN), decided to pursue delegated agreements with the big-name insurance companies in our area. AHN, which comprises seven hospitals and four ambulatory surgery centers throughout Pennsylvania, was looking for ways to increase revenue and reduce the number of delivered services that were later deemed ineligible for reimbursement.