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Ask the expert: What are CMS’s board certification requirements for initial credentialing?

Credentialing Resource Center Connection, February 11, 2010

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CMS standards do not specifically mention board certification. Nor is this criterion included in the Interpretive Guidelines for evaluation.

The Guidelines specifically state that the medical staff may not make its recommendation solely on the basis of the presence or absence of board certification but must consider all of the elements (evidence of current licensure, evidence of training and professional education, documented experience, and supporting references of competence).

The Guidelines state that a medical staff is not prohibited from requiring board certification in its bylaws when considering an MD or DO for medical staff membership or privileges, only that such certification may not be the only factor that the medical staff considers.
• Correspondence or secure electronic verification from specialty board
• Documented phone call with specialty board
• The ABMS or services designated by ABMS as an Official Display Agent
• AMA Physician Masterfile Report
• American Osteopathic Association (AOA) Official Osteopathic Physician Profile Report

Note: The AOA advises when verifying AOA board certification, contact the AOIA. Contacting the AOA specialty board results in a referral back to the AOIA directly (www.doprofiles.org, July 2009) for response and thus delays verification.

This week’s question and answer are from Verify and Comply, fifth edition, by Carol S. Cairns, CPMSM, CPCS.

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