1. Credentialing in Every Environment 41 st Annual CAMSS Education Forum Patricia E. Brown, BSCJ, CPCS May 16, 2012

2. The Role & Responsibility of the Medical Staff Service Professional Provider credentialing and privileging Maintaining governing documents Accreditation and regulatory compliance Quality and peer review

3. Why Do We Credential Healthcare Practitioners? It is a function required by accrediting bodies, payers, licensing standards and healthcare organizations must conduct in order to be deemed accredited Protects healthcare organizations from legal risk

4. Credentialing Tools...How Do They Assist You? Process applications effectively Ensure all accrediting bodies credentialing requirements are met Assist Credentials Specialist (CS) when struggling with processes (new or seasoned) Training new team members

5. Credentialing Tools Initial and recredentialing entity matrix Timeline evaluation/gap analysis Allied Health Professionals grid Colored folder- green, yellow & red

9. Auditing – Monitors Compliance Detects violations of accreditation and regulatory requirements and internal standards Audits should be proactive instead of reactive They may help avoid negligent credentialing lawsuits

10. Audit Tools Initial & reappointment audit forms Completed initial and reappointment applications checklist

13. Real Case Scenario – Dr. Red Dr. Red personally delivered his application, was “handsome and charming”. Offered to assist and was eager for his file to be completed ASAP CS followed basic initial application processing procedures File was completed at the set 60 day mark

14. Real Case Scenario – ***cont*** Medical staff office reviewed and concluded that file was incomplete Suggested practitioner to call our office and request application fee refund Phone call triggered in-depth audit using “The Onion Effect”

15. What is the Onion Effect? It is a process that takes place when you start looking into an issue as you peel away it makes you want to cry…but peeling the onion is required

16. Application Timeline

19. Literature Used to Create Tools Verify and Comply NAMSS – Comparative Differences of Regulatory Standards CMS Regulations and Guidance The Joint Commission Standards NCQA Standards (and ICE) C.A.S.E (copy and steal everything)

20. Questions Brown.Patricia@scrippshealth.org