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Credentialing interrogatories grow and change with evolving credentialing standard

Credentialing & Verification Update, January 30, 2008

Applications for medical staff membership have expanded over the years, and one of the most significant changes has been the growing list of questions (sometimes known as credentialing interrogatories) included on the application.

Organizations must develop credentialing applications that meet the needs of their facility as well as include all regulatory requirements. Failure to have a thorough, detailed application can leave an organization vulnerable to unnecessary legal issues.

Texas, for example, has mandated use of a standardized credentialing application. The application is long (12 pages) and poses questions regarding the applicant's past or present hospital affiliations, descriptions related to malpractice claims history, additional training, etc. All hospitals, HMOs, and preferred provider organizations are required to use this application for physicians at the time of initial appointment and reappointment, and hospitals have the option of using it for other practitioners. The application does not, however, include information that is mandated by The Joint Commission. Thus, most hospitals have supplemented the application with an addendum that is specific to their organization's requirements and that includes The Joint Commission's required terminology.

Without the addendum, the application itself does not ask questions that require a more in-depth disclosure by the applicant and can leave room for potential liability for negligent credentialing for the organization.

Joint Commission requirements
For hospitals, the Joint Commission standards are clear regarding the type of information that the medical staff must evaluate prior to granting privileges. Your organization must evaluate the following:

• Any previous or current challenges to a practitioner's license or registration
• Voluntary or involuntary relinquishment of a practitioner's license or registration
• Voluntary or involuntary termination of a practitioner's medical staff membership
• Voluntary or involuntary restriction of a practitioner's clinical privileges, including the limitation, reduction, or loss thereof
• Evidence of unusual patterns or a high number of professional liability actions that result in final judgments against the applicant
• Documentation of the applicant's health status

It is important to require applicants to provide a full written summary for any responses that require further explanation or details.

Note: This was excerpted from The Credentialing Coordinator's Handbook, HCPro, Inc., 2007.

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