Presentation on theme: "A Special Thank You to: Dr. David M. Yousem, M. D. , M. B. A"— Presentation transcript:
1 Credentialing, Accreditation, and Certification: What the Radiologist Needs to Know
2 A Special Thank You to: Dr. David M. Yousem, M. D. , M. B. A A Special Thank You to: Dr. David M. Yousem, M.D., M.B.A. Professor, Department of Radiology Vice Chairman of Program Development Director of Neuroradiology Johns Hopkins Hospital for allowing the use of his material/content in this presentation Dr. Yousem’s online lecture series can be viewed at: Dr. Yousem’s project was funded through an RSNA Educational Grant
3 In this presentation we will discuss: What is Credentialing? Who provides it and why is it needed?What is Accreditation? What is it important?What is Certification and Maintenance of Certification? How and when is it obtained?
4 What is Credentialing?Credentialing is a systematic review process used by a hospital or managed care organization (MCO) to assess and confirm that a physician is competent and qualified to practice medicine in their designated fieldThe landmark Darling v.Charleston Hospital case in the 1960’s established that hospitals had an obligation to verify the competency of the physicians who practice within its walls, and thus credentialing was born
5 Credentialing Committee Each hospital or MCO will have their own credentialing committeeThe committee is composed of various health care workers: doctors, nurses, physician assistants, administrators, etc. Having a radiologist on the committee is ideal since the committee determines the criteria necessary to grant specific privileges to individual physiciansThe committee also collects, reviews, and verifies various documents to ensure that a physician meets 6 core competencies: medical knowledge, technical skills, clinical judgment, interpersonal skills, communication skills, and professionalism.
6 Credentialing Support Databases Committees can use various credentialing support services to verify physician information:National Practitioner Data Bank:Provides information regarding malpractice claims, restrictions of privileges, professional society adverse sanctions, licensure actions by state boards, DEA reports, and CMS exclusion actions. Check your status atHealthcare integrity and Protection databank:Discloses any fraudulent Medicare or Medicaid claims AmericanBoard of Medical Specialties:DEA, CDS, Centers for Medicare and Medicaid Services (CMS)
7 Delay or Denial of Credentialing There are particular RED FLAGS that can delay or deny credentialing:Personal conduct history - Poor referencesDeferred letters - Alcohol or substance abuseMultiple malpractice suites - Short employment periodsUnexplained gaps in employment or educationIf there is a high risk that credentialing will be denied, it is in the best interest of the physician to resign before the committee investigates or makes their conclusion, as this denial of credentialing will remain on the physician’s permanent record
8 Delineation of Privileges The Credentialing committee also determines each physicians privileges depending on their specific training and skill levelFor example, the committee can specify the minimum number of CT, MR, US, myelograms, biopsies, etc that must be read or performed in a specific amount of time to obtain/maintain specific privilegesAgain, it is important for a radiologist to be on the committee to help determine these criteriaThese criteria ensure physicians, both radiologist and non-radiologist, are competent in their areas of care
9 RecredentialingOnce credentialed by a hospital, a physician must apply for recredentialing every 2 years to maintain their privileges
10 Why is Credentialing Important? A physician MUST be credentialed by a hospital to work therePart of credentialing is delineation of privileges for every hospital staff member, ensuring a physician’s competence in their particular skill set
11 What is Accreditation?Accreditation of a health care facility ensures that it is maintaining a high standard for the quality and safety of health care deliveryThe Joint Commission (formerly the Joint Commission Accreditation of Healthcare Organizations - JACHO) or the American Osteopathic Association (AOA) has the ability to accredit hospitalsPeriodic inspections and reviewsThe National committee for Quality assurance (NCQA) is a nongovernment agency that accredits MCO, PPOs, health plans, etcThe American College of Radiology (ACR) accredits imaging facilities
12 ACR Accreditation of Imaging Facilities ACR sets protocols and guidelines for imaging facilities to ensure image quality, equipment, and reporting meet the highest standards in quality and safetyACR evaluates the imaging equipment and the physician in a practice settingThis includes radiologists and non-radiologist imagers such as cardiologists, orthopedists, chiropractors, or any physician using imaging equipment in their practice
13 ACR Accreditation Factors evaluated by the ACR: Image quality Film storage and handlingPatient identificationRight and Left marker placementWritten reportsFrequency of equipment inspection
14 Why is ACR Accreditation Important? It not only ensures the quality of imaging and reporting but is also REQUIRED by some insurers to be reimbursedAccreditation also restricts non-radiologist from obtaining inadequate images or from obtaining images but not providing written reportsMore information regarding ACR accreditation can be found on their website,
15 What is Certification?Certification is a lifelong process by which the ABR and/or ABMS ensures that you, as a radiologist are adequately qualified and are involved in continued learning and improvementThere are two certification processes, both of which are awarded by the ABR:Initial certificationMaintenance of Certification (MOC)
16 To Apply for Initial Certification you must have: 5 years of approved training1 year clinical4 years in Diagnostic Radiology, which includes 4 months of Nuclear Medicine, 3 months of Mammography, and no more than 12 months in any one disciplinePassed all ABR examinationsCurrently: Physics, Written, and Oral ExaminationsFor the 2012 class and forward: a Core examination during R3-R4 year and Certifying examination 15 months after R4 yearCardiac life support certification, high moral and ethical standards, and proof of valid state licensure or Canadian equivalent
17 Certification and Recertification You have a 10 year period after completing training in which to obtain initial certification, which is valid for 10 yearsYou must then apply for Recertification through the ABR and/or American board of medical specialties (ABMS) to continue practicing as a radiologist
18 MOC: RecertificationTo become recertified, you must practice radiology, maintain an active unrestricted license and professional standing, pass the Maintenance of certification (MOC) exam, and meet the following specific requirements over a 10 year period:250 CME credits SAMMOC exam PQI projects
19 Specific Recertification Requirements: A Closer Look 250 category 1 CME credits70% in a subspecialty or area of practice, 30% general20 SAM (self assessment modules, each is 90 min)4 SAM must be in general knowledge, 16 in clinical contentAt least 6 need to be subspecialty specificMay overlap with the CME requirementSAM can be found on the ACR or subspecialty websitesMOC examinationComprehensive 4 hr knowledge based computer test80% clinical content, 20% non-interpretive skills including safety, life support, ethics, physics
20 Specific Recertification Requirements: A Closer Look 3 PQI (Practice Quality Improvement) projects in 10 yearsPQI project is a means of self-evaluation and continued quality improvementThe project must be in one of these five areas: patient safety, accuracy of interpretation, report timeliness and critical value reporting, referring physician services, practice guidelines.PQI projects can be designed by an individual radiologists, radiology practice groups or departments, institutions, healthcare systems, or by professional radiology societiesEvery radiologist participating may receive PQI credit for the projectMore PQI information can be found at
21 SummaryCredentialing is hospital based process which ensures physician competence and delineates physician privilegesAccreditation of a facility by the ACR assures imaging quality standards and is required for insurance reimbursementCertification and MOC by the ABR ensures that radiologists are involved in continuous learning and self-improvement
Your consent to our cookies if you continue to use this website.