Physician Credentialing and Progress Check David E. Kolva, MD SJHHC FMRP Practice Management

How is Everyone Doing? Decide on Type of Career? Decide on Type of Career? Location and Practice Structure? Location and Practice Structure? Applications and Interviews? Applications and Interviews? National Search Firm Experiences? National Search Firm Experiences? Negotiation Process? Contracts? Negotiation Process? Contracts? Individual Residents “Report In” Individual Residents “Report In”

Basic Principles of Licensure to Practice Medicine State Assigned Role as Police Power to Protect Public Health, not Federal Gov’t. State Assigned Role as Police Power to Protect Public Health, not Federal Gov’t. –New York= Education Department Office of the Professions. –California= Medical Board of California. –Nevada= State Board of Medical Examiners. Each State Determines Own REQUIRED Credentialing Items to Obtain License Each State Determines Own REQUIRED Credentialing Items to Obtain License

Basic Principles (cont’d.) Contact States Directly. Contact States Directly. Anticipate Delays of AT LEAST 60 Days (April- September worse due to New Grads, MD Transfers and Gov. Office Staff Vacations) Anticipate Delays of AT LEAST 60 Days (April- September worse due to New Grads, MD Transfers and Gov. Office Staff Vacations) Obtain Application and Requirements Obtain Application and Requirements Ask about Average Processing Time Ask about Average Processing Time Gather Proof of Prior Education, Training, and Examination Scores Gather Proof of Prior Education, Training, and Examination Scores FLEX, USMLE, ECFMG, FLEX, USMLE, ECFMG,

Basic Principles NEVER LIE ON APPLICATIONS. NEVER LIE ON APPLICATIONS. NEVER HIDE DEROGATORY INFORMATION FROM BOARD. NEVER HIDE DEROGATORY INFORMATION FROM BOARD. FULL and FRANK DISCLOSURE. Consult with Attorney if past legal problems. FULL and FRANK DISCLOSURE. Consult with Attorney if past legal problems.

Basic Principles – New York State Requirements Fee: $735 Fee: $735 Proof of Pre-Professional Education Proof of Pre-Professional Education Proof of Professional Education Proof of Professional Education –*IMG’s must give extra time for verification* Proof of Child Abuse ID Reporting Course Proof of Child Abuse ID Reporting Course Proof of Infection Control/Barrier Course Proof of Infection Control/Barrier Course Proof of Post-Graduate Training (Residency) Proof of Post-Graduate Training (Residency) Proof of Successful Examination Passing Scores Proof of Successful Examination Passing Scores

Basic Principles Physician Licensure Many States REQUIRE Completion of Coursework before Licensure, so be sure to check well in advance. Many States REQUIRE Completion of Coursework before Licensure, so be sure to check well in advance. Some States allow Licensure for IMG M.D.’s before Completion of Residency Training Programs Some States allow Licensure for IMG M.D.’s before Completion of Residency Training Programs

Acceptable Examination Requirements USMLE – Steps 1, 2, and 3 USMLE – Steps 1, 2, and 3 NBOME – Parts I, II, and III (D.O.’s) NBOME – Parts I, II, and III (D.O.’s) FLEX, NBME FLEX, NBME ECFMG Certificate ECFMG Certificate New York State has a LIMITED 3-year License for Visa waivers IF practice in underserved area New York State has a LIMITED 3-year License for Visa waivers IF practice in underserved area

Other Necessities: NPI NPI Number : National Provider Identifier. HIPAA created. Unique. NPI Number : National Provider Identifier. HIPAA created. Unique. Apply on-line, after licensure, at Apply on-line, after licensure, athttps://nppes.cms.hhs.gov/NPPES Free of Charge!

Other Necessities: DEA Drug Enforcement Administration – must register in order to prescribe controlled substances. Drug Enforcement Administration – must register in order to prescribe controlled substances. Use DEA FORM 224. Good for 3 years. Use DEA FORM 224. Good for 3 years. $551 $551

DEA (Cont’d) 26 states require a 26 states require a State Controlled Substance Number. State Controlled Substance Number. YOU MUST GET THIS # FIRST before you can apply for a DEA number! YOU MUST GET THIS # FIRST before you can apply for a DEA number!

Other New York Necessities All M.D.’s must enroll in the NYS Physicians Profile upon Licensure All M.D.’s must enroll in the NYS Physicians Profile upon Licensure Maintained by the NYS DOH Maintained by the NYS DOH

Medicare/Medicaid Provider Must Enroll to Treat Medicare/Medicaid Patients. Must Enroll to Treat Medicare/Medicaid Patients. Use FORM CMS-855 at Use FORM CMS-855 at Applications processed by your NEW LOCAL Insurance Processing Contractor Applications processed by your NEW LOCAL Insurance Processing Contractor

Worker’s Compensation Provider Providers must Enroll with individual STATE’S WC Board for Authorization to treat injured workers. Providers must Enroll with individual STATE’S WC Board for Authorization to treat injured workers. In New York, applications are processed by local County Medical Society In New York, applications are processed by local County Medical Society

Commercial Insurance Companies Credentialing Providers must enroll with EACH commercial insurance plan Providers must enroll with EACH commercial insurance plan CAQH has adopted Universal Credentialing Datasource (UCD) service to eliminate duplication and redundancy -HOWEVER- not all insurers are part of this network. CAQH has adopted Universal Credentialing Datasource (UCD) service to eliminate duplication and redundancy -HOWEVER- not all insurers are part of this network.

Internal Revenue Service Must apply for EIN (Employer Identification Number) if: Must apply for EIN (Employer Identification Number) if: –You are starting a Business –Will hire employees –Formed a Corporation or Partnership If you are practicing as a Sole-Proprietor, you use your own SS# for tax purposes, unless you hire employees. If you are practicing as a Sole-Proprietor, you use your own SS# for tax purposes, unless you hire employees.