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VERIFICATION
ROSTERS
Credentialing Offices are routinely inundated with verification
requests from other hospitals, managed care organizations,
etc. The volume of these requests can significantly interfere
with the Medical Staff Office’s ability to perform other important
functions. By providing a Verification Roster and appropriate
cover letter to those organizations who submit a high volume
of requests for verification, you can significantly reduce
the time spent in processing requests. In addition, by utilizing
a Verification Roster from facilities you frequently request
verification from, you can also significantly reduce the time
spent in obtaining these verifications.
Remember, though, your Verification Roster is a special list.
It should be dated, and should only include those practitioners
who are in good standing at your facility. For practitioners
who are not on your Verification Roster (example: inactive
practitioners, practitioners who may have had disciplinary
actions or sanctions against privileges), the requesting facility
should send an individual inquiry along with a signed Release
from the practitioner.
By the way – are you keeping copies of all those verification
requests you receive? Are you taking the time to copy them,
then file them? If you are, WHY? When I ask that question,
the response I usually hear is “because if they send a second
request saying they didn’t receive it, I have proof that I
did”. Be honest – wouldn’t it be easier to just print out
another verification than it would be to argue a little, then
go to the file, find the request, and re-send it? All that
extra time and paper is probably not adding any value at all
to your credentialing process. For routine inquiries, there
is little or no reason to maintain a copy. The only exception
to this is when the response you send indicates that the practitioner
is (was) not in good standing, or had disciplinary or other
actions. These responses you should keep in the file – and
be sure your responses on those individuals are consistent!
When in doubt, consult your hospital attorney.
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NEW
PHYSICIAN ORIENTATION
You received an application for medical staff membership and/or
clinical privileges to your facility. The verifications were
done, the department review obtained, the committees met and
reviewed, and the board approved. You just sent out the notification
from the board telling the applicant he/she has been approved,
and listed the department/section they are assigned to. You’ve
notified the appropriate departments that a new physician
is now on board. The credentialing process is complete – or
is it?
When that physician enters your facility for the first time,
will he know where to park? How to get an ID badge? Will he
know what the process is for admitting to your facility, or
who to call? What floor his patients will be admitted to?
Who the department chair is, and the director of nursing,
and their phone numbers? Will he know where the lab or radiology
are located? Will he be able to find the OR, and is he familiar
with the setup? Will he know how often the department meets,
and where, and whether or not he’s required to attend? Can
he find the doctor’s lounge? Does he have a copy of the formulary
for your hospital? Does he know where the dictation area is
located, and has he been provided with a dictation number?
Does he know where your office is located?
The answer to the questions above are – probably not! In today’s
healthcare, multiple facilities are vying for that physician
to admit patients or otherwise utilize their facility. Customer
Service (or being “user friendly”) plays an important role
in our credentialing process, but it shouldn’t stop there.
Once that physician has been approved to provide services,
we should continue to be “user friendly”. What better way
than to provide some orientation to your organization.
Providing new physician orientation can be accomplished in
a number of ways. One method is to schedule a one-on-one meeting
with the new physician and provide him/her with written information
about your facility. If the volume of new physicians each
month is too high, consider having a monthly “Orientation
Breakfast”, with a tour of the facility and presentations
by various departments (medical records, admitting, etc.),
along with some written information to pass on to his/her
office staff.
Regardless of the method used, it only make sense to provide
new appointees with a positive view of your facility and let
them know you’re glad they chose to affiliate with your organization!
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LEADERSHIP
ORIENTATION
Have you ever mumbled to yourself (or others) that you spend
twice as much time doing things for the medical staff because
Dr. X, who is the new Chief of Staff, or Dr. Y, who is the
new Credentials Committee Chairman, just don’t have a clue
what they’re doing? Well, chances are, they don’t have a clue
– because no one has told them exactly what their responsibilities
are, or given then tips on how best to carry out their responsibilities.
There are no classes in medical school or how to be an effective
leader, or how to chair a productive meeting.
Consider developing an orientation program for your medical
staff leadership. It could be one of the most beneficial things
you could do to improve the functions of your credentialing
and medical staff governance processes.
Who to include? The orientation program should be for incoming
leaders (Chief of Staff, committee chairs, department chairs)
as well as for potential leaders (those that are being “groomed”
for leadership down the road).
What topics should be covered? You can include any number
of topics, but be sure to provide them with a written scope
of the responsibilities (think “job description”) for each
particular leadership role. (Many times, the basis for these
job descriptions can be taken from the Medical Staff Bylaws.)
Provide them with tips on meeting management, and how to deal
with difficult people. It’s also helpful to walk them through
you’re organization’s specific governance or structure – in
other words, how often do various committees meet, what is
the reporting hierarchy for various committees, what information
should be reviewed/reported on a regular basis, etc.
Who provides this orientation? There are a number of ways
to go about this orientation. Assemble some key leaders (past
or present) and administrators in your organization who have
a reputation for being effective leaders, and have them give
tips to their success. You, as the medical staff services
professional, should also be a key player in this orientation,
explaining expectations, how things function, etc. There are
educational seminars available for physician leaders, or bring
in a consultant to provide some overall orientation, customized
specifically to your organization.
Regardless of what topics are included or who provides the
orientation, remember that it is much easier to be effective
if you have the right tools! By providing your leaders with
the necessary information that will help them be effective,
you not only improve the organization, but you might even
find that your office runs a little smoother!
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POLICY
& PROCEDURE MANUAL
Do you have a Policy & Procedures Manual for your office?
I don’t mean the Medical Staff Credentialing Manual that addresses
credentialing in general terms. I’m speaking of a P&P
that describes in detail how you carry out the functions within
your department. For examples, the Medical Staff Credentialing
Manual probably says that training and education will be source
verified. Your P&P should state exactly how you do that
(via letter, phone, fax, AMA Masterfile, etc.), who is responsible
in your office for doing it, what the timeframes are, how
long before you send out a second request, and on and on.
Your P&P Manual should not be limited to just those procedures
related to the credentialing process. It should also include
any other activities you or your staff are responsible for,
such as meeting management, your role in due process issues,
and your departmental quality improvement plan. It should
also include policies that are not routinely included in the
Bylaws or Medical Staff Credentialing Manual, such as archiving
of material, purging documents, access to files, and security/confidentiality
of practitioner files.
The creation and maintenance of a departmental P&P Manual
also provides an excellent outline for developing a job description,
or showing evidence of the scope and complexity of the duties
performed by your and your staff. The P&P Manual also
serves as an excellent training manual for new employees.
The premise behind a P&P Manual for the Medical Staff
Office (or Credentialing Department) is so processes that
are in place can be carried out appropriately and consistently.
It serves as an excellent resource and day-to-day planner.
It benefits both you, your staff, the medical staff and the
facility by describing in detail the functions you perform,
and ensuring that they are carried out in a consist manner.
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UNNECESSARY
PAPER
Are you still requesting and filing copies of a practitioner’s
license to practice? What about all those certificates of
training or diplomas from medical school or residency programs?
Are you still asking for a notarized copy of their board certification?
WHY? How does it add value to your credentialing process?
Most accrediting bodies require an entity to obtain source
verification of licensure, education and training. Copies
(even notarized copies) of these documents are not considered
source verification.
Unless it’s specifically required by a state law, there is
probably little reason to either request or keep these unnecessary
pieces of paper. If you are required by a specific contract
(e.g. delegated credentialing contract), I’d certainly try
to find out why that organization is requiring you to collect
these documents. Sometimes and little conversation and clarification
can save you a lot of work in the long run.
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