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NCCHCA Conference/Asheville, NC June 22, 2012  What are you here hoping to learn?  Tell us about you: CHC, location, responsibilities  Credentialing.

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Presentation on theme: "NCCHCA Conference/Asheville, NC June 22, 2012  What are you here hoping to learn?  Tell us about you: CHC, location, responsibilities  Credentialing."— Presentation transcript:

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2 NCCHCA Conference/Asheville, NC June 22, 2012

3  What are you here hoping to learn?  Tell us about you: CHC, location, responsibilities  Credentialing questions, concerns, etc. 2

4  Darlene Nicgorski MS Ed, PHR  Human Resources Consultant  VP HR/Credentialing at Piedmont Health  Interim at Wake Health Services  NACHC Consultant  NCCHCA Consultant  Contact: 

5  Recognize the multiple purposes for which credentialing & privileging are necessary  Recognize and pay homage to the importance of the process  Learn some strategies for developing policies and procedures  Identify the elements of a system  Know of resources to assist in developing policies, procedures and processes. 4

6  Quality Care & Patient Safety: Ensures the background, including education, certifications, licenses and competence of providers.  Risk Management: Reduces risk of lawsuits for failure to credential or for negligent credentialing. 5

7 Credentialing is the process of verifying and recognizing that a licensed healthcare practitioner is currently qualified to practice his/her profession for which you are offering employment. 6

8  The process of defining the specific scope and content of patient services that a practitioner can provide.  The organization grants privileges only for services that are within its “scope of service” and can be supported by the organization.  This process includes a peer review to support credentialing and an appeals process. 7

9 8  BPHC: FTCA  The Joint Commission Great resource book: Credentials Review and Privileging: Questions and Answers for Ambulatory Care  AAAC Similar to The Joint Commission list resourceshttp://www.aaahc.org  Patient Centered Medical Home  Your Insurance Carriers (Not a subject for today) including Medicaid & Medicare

10 Licensed Independent Practitioners LIPs— “individuals permitted by law and the organization to provide direct patient care services within the scope of their licenses and individually granted clinical privileges.” Joint Commission p. 5  MD, DO, FNP, PA, CNM, DDS, DMD, LCSW  This list is not inclusive. 9

11 10  All other licensed/certified professionals who need licenses to do their jobs.  Examples, but not inclusive: DH, Pharmacists, RN’s, Etc.  FTCA and Joint Commission have made a push for this in the last 5 years.

12 In most CHC’s it is handled by HR staff. In some by the CMO’s staff and occasionally the Exec Admin for the CEO handles this function. It is important to have a clear process in place. 11

13  A committee that includes the Clinical Directors, HR Director and Quality Director.  Hold regular meetings.  Write policies and procedures.  Review regularly or audit the process  Determine how new LIP’s get presented to the board.  Educate the board about their critical role in granting privileges. 12

14  Before the hire date.  Application given or sent to appropriate candidates well in advance of hire date.  NO PROVIDER SHOULD BE ALLOWED TO START UNLESS THE FILE IS COMPLETE. STOP 13

15  Emergency Situations—Not the Norm  Missed the Board Meeting  All verifications, checks, queries completed  Missing the Board Approval  Other ways to handle this. Executive meeting of Board Conference call with the Board 14

16  Failure to adopt/follow state licensing requirements  Failure to follow the health center’s own rules and regulations, policies and core privileging criteria  Failure to employ standards of national accrediting organizations  “Rubber stamp” reappointment—failure to consider provider’s accumulated quality and performance improvement data 15

17 16  Loss of accreditation  Malpractice claims  Loss of FTCA  Loss of confidence by patients  Bad employee morale  Bad reputation in community  Difficulty recruiting and retaining providers

18  Don’t reinvent the wheel.  Sample application Caswell Family Medicine  There are many samples available online. 17

19  CV, Resume  Application and signed release  3 letters of reference  Copy of current NC license verified online  Copy of current DEA certificate  Current Board Specialty Certificate 18

20  OIG Office of Inspector General  NPI National Practitioners Identification  Verification of Education, Training and Graduation  Excluded Parties List System (EPLS)  NPDB National Practitioners Data Bank And enroll in the PDS Proactive Discloser System  Appropriate Board Specialty 19

21  It is important that the files be kept in a set order—what goes on left side on top, etc. so when anyone is checking for a dental license, they can find the current one quickly and all others.  Review—audit—every folder once a year.  See “Guide for Preparing Files for an FTCA Site Visit.” on the clinical site of ecri. 20

22  There are many available.  Don’t reinvent the wheel. Use some samples and create your own.  The Joint Commission book has some.  The ECRI Credentialing Toolkit.  NACHC is developing a Credentialing Toolkit. 21

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24  There are the paper files: who sees these? Confidentiality is critical.  Create a system that is usable by more than one person.  Scan documents or save electronically per provider.  Use your electronic calendar to remind of tasks and due dates, etc. 23

25  Part of initial credentialing  Part of re-credentialing process  Integrated into quality process  Maintain provider confidentiality  Improvement Process  Not a “Rubber Stamp Process”  With EMR information look at data and trends, continuous auditing 24

26  Health Care Quality Improvement Act provides immunity when conducting peer reviews in good faith  Provides protection from discovery  Peer review as educational process  Ongoing process to detect problems 25

27  The Joint Commission has a limit of no more than 2 years  Reviewed and renewed when there is a change: Scope of service of provider Scope of service of organization Any restrictions on license, etc. 26

28  BPHC See policy attachment FTCA HRSA  The Joint Commission Great resource: Credentials Review and Privileging: Questions and Answers for Ambulatory Care  AAAC Similar to The Joint Commission list resourceshttp://www.aaahc.org  Patient Centered Medical Home  Your Insurance Carriers (Not a subject for today) including Medicaid & Medicare 27

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30  Don’t Reinvent the Wheel  Sharing Resources on the  HR Clearinghouse  June 26, 2012 – 2-3:00 PM, EDT  Online Registration Deadline: June 24, 2012 Online Registration Deadline  This session will inform and demonstrate the availability of a wide range of resources on the HR Clearinghouse.  Why this webinar will benefit you and your staff?  By the end of this webinar, you will be able to:  1. Find the HR Clearinghouse on the NACHC website;  2. Use the Clearinghouse to search and submit resources;  3. Use the Clearinghouse to ask an HR-related question of their colleagues.  Speaker(s):  Betsy Vieth, Director, Governance and Human Resources Support, National Association of Community Health Centers, Bethesda, MarylandHuman Resources  Who should attend this webinar?  Health center and PCA HR staff and other management team members. Health center CEOs and PCAs Health center  Registration Rates There is no charge for this webinarwebinar  Register online here. Register online here. 29

31  Medical Board  Dental Board  DEA https://www.dealookup.com/TestDB_Signup.asp  OIG  NPI https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do  EPLS https://www.epls.gov/epls/jsp 30

32  NPDB hipdb.hrsa.gov/index.jsphttp://www.npdb- hipdb.hrsa.gov/index.jsp  AMA - https://profiles.ama- assn.org/amaprofiles/https://profiles.ama- assn.org/amaprofiles/  ABFM https://www.theabfm.org/index.aspxhttps://www.theabfm.org/index.aspx  NCBOP 31

33  Hopefully we have unraveled the mystery. 32


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