Corporate Compliance

How to audit credentialing and privileging practices

Healthcare Auditing Weekly, October 11, 2005

For the next several weeks, we will discuss how to audit your organization's credentialing and privileging practices.

We will cover how to identify whether an organization's credentialing and privileging practices complies with accreditation, regulatory, and patient safety standards. We will also review how to identify opportunities to streamline the credentialing and privileging procedures.

We'll start by reviewing the structure of the medical staff's office (MSO) credentialing and privileging practices. To begin this process, read and evaluate the following documents:

  • Medical staff bylaws

  • Interviews with MSO representatives

  • Medical staff privilege request forms

  • Medical staff application and reapplication forms and related documents

  • Medical staff credentials' files

  • Allied health credentialing and privilege forms and related policies and procedures

  • Other related policies, procedures, and forms the MSO uses in the credentialing and privileging process

    Next week, we will continue our discussion with steps for reviewing medical staff bylaws.

      The above tip is an excerpt from the book "Hospital Auditing and Monitoring: Sample Programs for Key Risk Areas." Copyright 2004 by HCPro, Inc. This book is a step-by-step, practical manual that offers sample audit programs for the most troublesome areas that a hospital must audit. The binder and CD-ROM are filled with actual audit programs used by auditors and compliance officers in the field. Click here for more information or to order your copy today.

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