Welcome to Credentialing & Verification Update!
This new bi-weekly e-zine is specifically geared to Credentialing and Privileging Desktop Reference users.
Twice a month, we'll send you brief articles, tips, news, and regulation updates that address the credentialing and verification issues and challenges that matter to you the most.
Back to top
Perform credentialing audits to monitor compliance and check outcomes
Perform credentialing audits to monitor compliance with various processes involved in credentialing and privileging and to check the outcomes of these processes. Many aspects of credentialing lend themselves to an audit. The focus of an audit will depend on the data that the organization seeks about the credentialing process.
When organizations monitor compliance, they are checking whether they meet expectations and are detecting any violations of "the laws" (i.e., accreditation and regulatory requirements, as well as internal standards) applicable to credentialing and privileging. Performing credentialing audits is similar to conducting patient record audits in that it is usually more productive to audit specific aspects of the process to answer explicit questions.
Perform credentialing audits to monitor compliance by determining whether:
- all practitioners who provide care or services in a healthcare organization are properly credentialed and privileged.
- practitioners exercise only those privileges that they have been granted.
- the credentialing of physicians and other practitioners is performed in compliance with state, federal (i.e., the Centers for Medicare & Medicaid Services, the Health Care Quality Improvement Act [HCQIA]), or accreditor (i.e., National Committee for Quality Assurance, The Joint Commission) requirements.
- the organization is in compliance with its own internal credentialing standards as stated in bylaws, documents that supplement the bylaws, credentialing policies and procedures, privilege delineation criteria, etc.
- methods are in place to ensure that all licensed independent practitioners are continuously licensed, have professional liability insurance, maintain U.S. Drug Enforcement Agency registrations, etc.
- adequate systems are in place to ensure that all practitioners are credentialed and reappointed within permitted time frames.
- the organization is in compliance with the HCQIA by querying and reporting to the National Practitioner Data Bank, as required by federal law.
- information was available to make a decision but was not obtained.
- evaluators make use of all information available when recommendations are made to the organization's governing board.
Back to top
Q&A: What tips can you provide for dealing with physicians who don't take the credentialing process seriously?
A: This is a common question among medical staff professionals (MSPs), who often deal with physicians who won't return paperwork on time, are difficult or impossible to reach, or simply do not take the credentialing process seriously, as stated in this reader question.
Below, we outline three tips for dealing with individuals who hamper the credentialing and privileging processes.
Tip 1: Dealing with non-responsive or late physicians: Some MSPs have had success increasing responsiveness from practitioners by personally walking into their offices and waiting as the practitioner fills out the paperwork. While this may not be a tactic needed frequently, those who have tried it report that the individual was more responsive the next time around.
Tip 2: Applying peer pressure to get results: Try publishing a list of the physicians who have failed to respond to requests for information. List the names of responders and non-responders side by side, with a "thank you" to those who have already completed the requested paperwork.
Tip 3: Getting support from above: When dealing with non-compliant physicians, often the cooperation of the department chair or credentials committee chair can be effective. They know firsthand the volume of work associated with the appointment and reappointment processes. Often, they are willing to intervene when it appears that all other avenues of getting the physician to cooperate have failed. | 
