6 Best Practices for Avoiding Negligent Credentialing
The consequences of negligent credentialing can be costly to a healthcare organization and its medical staff services department. Organizations that want to renew their focus on credentialing can follow several best practices to protect themselves and ensure they’re doing all they can to remain compliant.
Pay Attention to Criminal Background Checks
A criminal background check is an important part of the credentialing process. “Criminal background checks fill in any potential gaps in credentialing search efforts and help to assure that those gaps do not present quality of care or safety concerns for the organization and its patients,” says Jesse Adam Markos, of Wachler & Associates.
Check and Recheck
"Even if you’ve done the required checks on current employees, it’s vital that you continue to monitor everyone on staff," says William Copeland, President of Copeland Law LLC. Don’t forget to include criminal background “rechecks” in your process at time of reappointment or any time there are changes in privileges.
Be Aware of the OIG
The U.S. Department of Health and Human Services Office of Inspector General has added “oversight of hospital privileging” to its list of focus areas, Markos says. “The challenge for hospitals and medical staffs in this environment is to ensure that their credentialing process is fully compliant with evolving accreditation, licensing, Medicare Conditions of Participation and other applicable credentialing requirements.”
Tie Credentials to Quality Care
Receiving credentials should be tied to the quality of the practitioner's outcomes, says attorney Margaret J. Lowery, of Lowery Law. “Since the ACA is measuring payment through quality, institutions can no longer afford to keep physicians on staff who are having consistent poor outcomes. The quality of care, such as outcomes, must also be reviewed. This is especially true since quality studies have validated the correlation between quality and outcome.”
Check Your Minimums
“Review with the medical staff the minimum number of cases to maintain privileges,” Lowry says. “Some institutions set a low threshold for the number of cases or procedures, and in my opinion, this may create exposure for negligent credentialing.”
Know What’s at Stake
Getting credentialing wrong can be a serious blow to your organization. “First, there is a loss of reputation to the institution and to the medical staff with just a mere allegation that you brought in an unqualified practitioner,” Lowry says.
Secondly, it is expensive, not only in terms of costs of defending the credentialing process, but also if the failure to properly credential a practitioner is the reason a patient is harmed, Lowry says. “Credentialing professionals are the gatekeepers who ensure that qualified individuals become appointed and reappointed to an institution’s medical staff.”
Copeland agrees. He says he’s seen providers excluded from Medicare/Medicaid programs and peer-review processes because they hadn’t run proper background checks. With all this in mind, healthcare organizations would be wise to put a renewed focus on credentialing. Following these best practices can help ensure success.
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