Top 7 Credentialing Practices for Hospitals

Author: William Mack Copeland
1. Prioritize Quality
The main agenda of a hospital’s credentialing effort should be lending quality care to its patients. The hospital should put effort in building a credentialing process that identifies highly qualified physicians and offers privileges and treatments corresponding to their qualifications and current competency. A hospital which compromises on its quality standards due to a shortage of physicians is running an increased risk of violating the responsibility of reasonable care in credentialing.
2. Stick To Hospital & Medical Staff Bylaws
If you have an established credentialing process or regulation, follow it. One of the simplest ways to deal with the hospital’s conduct in a credentialing case is to exploit the failure of the hospital to abide by its own policies and practices. These policies and practices need to be in compliance with the state law, accreditation standards and the Medicare Conditions of Participation. Always document compliance with all your procedures and policies. If you keep something undocumented, litigants and regulators will argue that it did not exist or does not happen.
3. Develop a "Red Flag" System
The majority of medical staff applications for joining and rejoining employment raise no issues and poses low risk of negligent credentialing. However, certain types of information submitted in an application may warrant a lot more scrutiny. For example, medical practitioners with an astonishing number of medical liability claims, judgments or settlements should be put to a much detailed review. A physician’s interpersonal and clinical competence should be reviewed in the light of Criminal convictions, licensing sanctions, hospital disciplinary actions and patient and staff complaints. If a hospital wants to credential a doctor with a “red flag” in his or her background, the hospital must perform additional analysis to explain its gesture.
4. Analysis of career Gap
In case the hospital authority finds gaps in the application, apparent responses should be scrutinized and follow-up requests for information may be requested. An applicant having “red flags” background may try to evade a hospital’s “red flag” tracking system by excluding such information from the application. Such deliberate omissions must be considered as a ground for rejecting an application. But the hospital must be reasonably assiduous in recognizing any “gaps” in the applications and any suspicious answers.
5. Verify Facts
Verification of all the vital facts mentioned by an applicant in an application form is the central component of credentialing. Once the verification process is complete, document the process. Documentation is as important as verification because if you cannot prove you did it, a regulator or the court may conclude that you did not do it. Bylaws should incorporate a provision that if relevant information is withheld or proves to be false or misleading through the verification process then corrective action will be taken.
6. Clinical Privileges to Medical Staff
Hospitals use a variety of reasonable techniques to provide clinical privileges to medical staff. Some might offer a set of “core privileges” privileges based on the competence of each and every that all members of the medical staff may exercise and attach definite specialty practitioner. If a negligent credentialing act comes to light, hospitals should revisit the privileges awarded to the members of the medical staff members to be assured that the privileges of physicians reasonably match their documented competence.
7. Board Involvement
The governing body of the hospital is responsible for the quality of care it provides. Before appointing a physician the medical board must check whether all of the hospital and medical staff bylaws and regulations are followed in this case and are these provisions compliant with licensing, accreditation and other related requirements, does the physician possess any “red flags” to his background etc..

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