What They Dont Teach You in Medical School

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What They Dont Teach You in Medical School

• (Steps in Medical Staff Credentialing)
• March 13, 2008
• Judi Smedra, CPMSM, CPCS Director, Medical
  Staff Affairs The University of Kansas Hospital

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CREDENTIALING

• Process of obtaining, verifying, and assessing
  the qualifications of a healthcare practitioner
  to provide patient care services in or for a
  healthcare organization

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(No Transcript)
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WHOS WATCHING YOU NOW?

• The Joint Commission (H)
• National Practitioner Data Bank (H)
• Managed Care Organizations (H)
• Hospital Boards (Ultimate Authority) (H)
• CMS (Medicare)
• Medicare/Medicaid StateProfessional Review
  Organizations
• State Board Of Healing Arts
• Managed Care Accrediting Agencies (M)
• Credentials Committee (Final Decision) (M)

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WHAT ARE THEY LOOKING FOR?

• Quality Patient Care
• Efficient Patient Care
• Length Of Hospitalization
• Legible Charts
• Medical Records Compliance
• Citizenship (H)
• Privileges Requested MatchPrivileges Performed
  (H)
• Continuing Medical Education (CME)Pertains To
  Specialty (H)

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APPLICATION PROCESS WHAT TO EXPECT

• Group Practice Dictates Where You Practice How
  to Obtain Application
• Be Complete Accurate
• Privileges / Membership Will Not Be Granted
  Overnight!
• Expect Application Fee and/or Dues

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APPLICATION PROCESS MAKE IT EASY ON YOURSELF!

• Account for All Time Periods Month Year (must
  document gaps gt 30 days)
• Training
• Affiliations / Work History
• Insurance Carriers
• State Licenses

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APPLICATION PROCESS MAKE IT EASY ON YOURSELF!
(continued)

• References (must be in your specialty)
• Medicare/Medicaid Provider Numbers
• NPI (National Provider Identifier)
• Signed Attestation / Release (authorization)

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PRIVILEGES

• Will Be Required To Produce Documentation Of
  Training And/Or Experience
• Proctoring May Be Required For Specified Time
  Period Or Number Of Procedures

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DOCUMENTATION CHALLENGES

• Curriculum VitaeDates (include Month
  Year)Identify Custodian of Records for Closed
  Training Programs/Affiliations
• LicensureKansas Postgraduate LicenseMissouri
  Temporary License for Training
• Diplomas / CertificatesMedical School, Training
  Programs, Boards

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DOCUMENTATION CHALLENGES(Continued)

• DEA CertificatePrescribe/Administration of
  DrugsKansas/Missouri
• BNDD
• Change of Address
• Case Log
• Photograph For Identity
• Compliance Training/Exams (HIPAA,Privileges)

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PRIMARY SOURCE VERIFICATION

• Direct Contact With Sources To Guarantee That
  Statements Are Legitimate, Unchallenged
  Appropriate

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TYPICAL VERIFICATION

• Completed Application - All Activity from Medical
  School to Present
• AMA OR AOA Profile
• Verification Of All Licensure
• Training Competency
• Board Certification
• ECFMG (If Applicable)
• Criminal Background Check
• Malpractice Claims History

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TYPICAL VERIFICATION (Continued)

• Group Practice Affiliations
• NPDB Report (H) HIPDB Report (M)
• Peer References
• Office Of The Inspector General
• General Services Administration
• Timeframe
• Burden Of Proof Is On You!

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REAPPOINTMENT

• Provisional / Probationary (H)
• Joint Commission Every Two Years (H)
• NCQA (Managed Care Organizations) Every Three
  Years (M)

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MEDICAL STAFF COORDINATOR

• Your Best Friend or Worst Nightmare Your
  Choice!