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v | |
| About the author |
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vi | |
| Introduction |
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viii | |
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Credentialing's key roles: Patient protection, practice facilitation, and institutional protection and support |
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1 | (6) |
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3 | (1) |
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The four steps of credentialing |
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4 | (3) |
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Preparing your files for a credentialing audit |
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7 | (16) |
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Monitoring compliance through auditing |
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7 | (1) |
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Targeted areas for monitoring compliance |
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8 | (1) |
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Deciding which standards will guide the credentialing audit |
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9 | (3) |
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Sample tool: Verification methods requirements |
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12 | (11) |
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Selecting a method for conducting credentialing audits |
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23 | (72) |
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Issues #1 and #2: Are all practitioners who provide care or services in a healthcare organization credentialed? Have all practitioners been granted the necessary privileges for the care or services they are providing? |
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25 | (5) |
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Issues #3 and #4: Is the credentialing of practitioners being performed in compliance with state, federal (e.g., CMS, HCQIA), JCAHO, and NCQA requirements? Is the organization in compliance with its own internal credentialing standards, as stated in the medical staff bylaws or supplemental documents, credentialing policies and procedures, or privilege delineation criteria, etc.? |
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30 | (35) |
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Issue #5: Are methods being used to ensure that all LIPs are continuously licensed and have professional liability insurance, DEA registrations, board certification, and other items that are subject to expiration and that should be updated in accordance with external or internal requirements? |
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65 | (4) |
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Issue #6: Are all practitioners credentialed and reappointed within the permitted time frames? |
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69 | (6) |
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Issue #7: Is the organization in compliance with the HCQIA by querying and reporting to the NPDB as required by federal law? |
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75 | (7) |
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Issues #8 and #9: Have information or decision errors occurred? |
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82 | (13) |
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Setting up routine audits and staying on schedule |
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95 | (8) |
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95 | (1) |
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Random, systematic, and stratified sampling |
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96 | (2) |
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Capture and document essential information |
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98 | (1) |
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What should you audit, and how often? |
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98 | (5) |
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Complying with regulators, reducing liability, and avoiding negligent credentialing lawsuits |
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103 | (6) |
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The value of conducting regular audits |
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103 | (2) |
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Practical ways to apply audit results |
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105 | (4) |
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Using credentials audits as the basis for an annual report |
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109 | (20) |
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Ensure that the credentials committee ``owns'' the report |
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110 | (8) |
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Highlight weaknesses in the process, not in individual performances |
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118 | (6) |
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Data to include in an annual credentialing report |
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124 | (1) |
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Designing your annual credentialing report |
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125 | (2) |
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127 | (2) |
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Conducting a delegated credentialing audit |
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129 | |
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Delegated credentialing, defined |
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129 | |
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NCQA standards for surveying delegated credentialing files |
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130 | |
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Auditing in managed care organizations: Going paperless |
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130 | |
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137 | |
