Credentialing scoop I wish someone would have told me

Credentialing scoop I wish someone would have told me
credentialingIf you do your own facility credentialing, you know how time consuming and detailed it can be.  Keeping up with the regulations and making sure everything is current is challenging enough, then the re-credentialing process is looming before you know it.
Here is some scoop I wish someone had told me:

Include a by-laws attestation statement as part of your application process for the potential credentialed staff signature.  It shows that the applicant understands the facility by-laws and agrees to abide by them.  An added sentence can be piggy-backed on an existing document to reduce paperwork, such as the request for appointment or re-appointment.

As part of your due diligence, don’t forget to run an OIG check to ensure there are no Medicare sanctions assigned to your applicant.  Here is the link:

Make sure you maintain a current photo ID in each file.  Replace the copies as they expire.

Verify that your applicant’s insurance meet liability limits minimums as defined in your by-laws.

When you enter your applicant into the National Practitioner Data Bank, set them up for continuous query, so you are alerted to any changes immediately.  This also saves a new query at re-application.  Create an e mail file when your receive NPDB emails to support your process.

Maintain the applicants health file in a removable folder.  It allows for those documents to be pulled if the file is requested.  Place any health information including TB, Hepatitis B, History and Physical, and flu information in the file.  Add any documentation related to illness or injury as needed.

Don’t forget to verify all licensure and certifications, both initially and when renewed.

Track when documents need to be renewed in your e-mail calendar as an appointment with a  reminder notice.

When re-appointment occurs, have your Governing Body check a statement indicating that peer review activities have been reviewed and considered as part of the approval process.

Make sure you require a new application with each re-credentialing period.  If your state doesn’t require a standard application, verify that there is a information/liability release statement.

Delineation of Privileges:  Have the applicant request and the Governing Board approve each procedure.  Include CPT codes for easy reference.  Once approved, provide a copy to the scheduler so he/she knows what is appropriate to schedule.  Upon re-appointment, have a document for the applicant to sign and request either no changes, or indicate any requested changes with the correlating CPT code.  Don’t forget any items for oversight ie:  fluoroscopy or conscious sedation.

Once appointment is granted, provide the applicant with a letter indicating the appointment period, and a reminder that the appointment is based on adherence to the facility by-laws.  Put the new re-appointment date in your calendar.

Keep a checklist in each file of all documents with a list of their outdates.  Maintain each file with tabs in a uniform fashion to keep it organized.  Archive the old as the file grows per your facility’s record retention policy.

My last, and most important credentialing advice:  Since the process is both time consuming and critical, delegate or outsource when you can.  Happy Credentialing!


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