Medical Staff

MSP Advisor: Credentialing basics are not just for beginners!

Medical Staff Leader Insider, September 24, 2008

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Dear credentialing colleague,

Do you have new medical staff services professionals on staff and need to show them the basics? Try including these four steps to credentialing in your orientation package to get them started. These steps can also be a valuable resource for seasoned MSPs in your office. Although they seem pretty basic, in my work as a consultant, I often find that there are weaknesses in the implementation of these steps. Why? Because sometimes the simple things get lost in the chaos of daily work.

Step 1: Establish policies and rules. This is the framework that defines your credentialing process. Well-written policies and rules ensure a thorough and consistent credentialing practice. Get a copy of your hospital’s credentialing procedures and read them thoroughly.

Step 2: Collect and summarize information. It is through the verification process that you can identify red flags. For example, if an application shows gaps in a physician’s employment history, or if a physician has moved from hospital to hospital, ask the physician to explain the circumstances that led to these events. Make sure you query primary sources (the medical school the physician graduated from, the hospital where he or she completed a residency program, and any hospitals he or she has been affiliated with) in accordance with accrediting body and regulatory agency requirements.

Step 3: Evaluate and recommend. This is where your medical staff leaders really get involved—the credentialing committee reviews the data MSPs have collected on medical staff applicants and make recommendations to the board based on this data. One of your many duties as an MSP is to ensure new medical staff leaders are oriented to these duties. These ongoing educational efforts will help medical staff leaders determine who will practice at your hospital.

Step 4: Review, grant, deny, or approve. Remember, only the board of directors has the final authority to grant membership and privileges (after receiving recommendations from the board), but your research can make a difference in the final decision. 

A solid credentialing process helps keep patients safe, maintains the quality of your medical staff, and preserves your hospital’s reputation. As an MSP, you have many responsibilities, but this is your most important.

Look for this column next month when I’ll discuss developing an objective, criteria-based clinical privileging system.

Until next time …SMILE!

Donna K. Goestenkors, CPMSM
Consultant – Credentialing & Privileging Practice
The Greeley Company



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