• E-mail
• Print
• RSS

Q&A: I’m aware that I must query primary source hospital affiliation, but must I verify all practice experience and clinics. How far back must I go?

Credentialing & Verification Update, October 10, 2007

A: Each hospital must decide how far back to go in verifying past affiliations. While some verify every current and past hospital affiliation, others verify only the past five to 10 years. Another option is to verify all hospital affiliations prior to the implementation of the National Practitioner Data Bank in 1990 with the notion that any disciplinary action taken by hospitals will be available in this report.

The main reason to verify work history and healthcare facility affiliations is to ascertain current clinical competence. Typically, such requests will include dates on staff, current staff status or category, disciplinary actions, and whether the privileges requested are consistent with those held at the facility being queried. The requests may also ask specific questions regarding number of procedures performed and the outcomes for these procedures. Since the emphasis is on current competence, experience from many years ago may not be relevant. The medical staff may choose to set a defined cut-off date, which may vary by practitioner specialty.

Another aspect of this verification focuses on risk management as it relates to negligent credentialing. Many hospitals feel it is important to document a provider's whereabouts and clinical activity for the period from medical school through the date of the application to ensure that there are no unaccounted for periods of time that may be "red flags" indicating a problem. For example, a provider who spent time in a drug/alcohol rehabilitation facility may attempt to hide this by stating that he or she was on staff at a hospital during this time. Verification of the dates on staff at each hospital may turn up the discrepancy.

It is also important to determine whether any disciplinary action was taken against a practitioner at a prior hospital. The Medicare Conditions of Participation for hospitals specify in §482.12(a)(6) that the criteria for medical staff selection are individual character, competence, training, experience, and judgment. Work history can provide a tool for evaluating these areas.

The Joint Commission's (formerly JCAHO) hospital accreditation standards do not have a specific requirement for verification of work history. The standards require, at the time of appointment to membership and initial granting of privileges, that verification of relevant training or experience must be obtained from the primary source(s), whenever feasible.

Regardless of the process the hospital chooses to implement, it must believe there is sufficient information on which to base a reasoned decision that the applicant can provide-in a safe, competent manner-the patient care services that he or she is requesting.

Editor's note: Kathy Matzka, CPMSM, CPCS-a Lebanon, IL-based speaker, consultant, and writer with over 20 years of experience in medical and professional staff services-fielded this question. Questions and topic suggestions can be e-mailed to CVU at mcoler@hcpro.com. We'll find an expert or resource to tackle the credentialing or verification issues that are challenging you.

• E-mail to a Colleague
• Print
• RSS
• Archive