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Privileging outside physicians

Credentialing Resource Center Connection, August 23, 2007

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Sally J. Pelletier, CPMSM, CPCS, is a consultant with The Greeley Company, a division of HCPro, Inc., specializing in the areas of credentialing and privileging.

Dear credentialing colleague:

Last week, I had the pleasure of working with a very dedicated medical staff and medical staff services team in the development of their criteria-based core privileging system.  There were a couple of special circumstances that we discussed-including what the organization requires in terms of "privileges" for "outside" physicians (those who do not have an affiliated relationship with the hospital) who are ordering diagnostic tests or writing orders for outpatient care. 

This issue is addressed in detail in the following excerpt from The Compliance Guide to the JCAHO Medical Staff Standards by Kathy Matzka, CPMSM, CPCS:

"In some cases, hospitals may perform outpatient services (such as performing lab work, filling prescriptions, or providing services such as physical therapy) for the patient of a physician who does not have a relationship with the hospital.

If state law and regulation requires an order from a licensed independent practitioner (LIP) to perform laboratory test or radiology procedure or to provide outpatient care such as physical, occupational, or speech therapy, then the organization needs to determine that the person ordering the tests, procedures, or case is licensed by the state before he or she does so. In this type of situation, at a minimum, the hospital should establish that the practitioner has a current, valid license and is practicing within the scope of that license in ordering the lab test, medication, or therapy. This can easily be accomplished by an Internet verification of licensure when taking the order for the service. Do not delegate this responsibility to the medical staff services department, which should only be responsible for credentialing practitioners who are being credentialed and privileged through the medical staff process.

Orders or prescriptions from out-of-state practitioners can be recognized if state law permits, but the hospital should check for a current, valid license; controlled substance license; and Drug Enforcement Agency license in the practitioner's home state."

Remember, credentialing has no other master than the patient.

That's all for this week.

All the best,

Sally J. Pelletier, CPMSM, CPCS
http://www.greeley.com/consulting.cfm

Editor's note: Sally Pelletier was elected to the NAMSS Board of Directors last week and will serve as secretary for 2008. This is a tremendous accomplishment, and we wish Sally the best in her new role.

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