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Tip of the week: Conduct a self audit to ensure compliance with credentialing standards

Medical Staff Leader Connection, December 16, 2009

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Performing credentialing process audits is similar to conducting patient record audits in that it is usually more productive to audit specific aspects of the process to answer specific questions. This is as opposed to attempting to audit an entire credentials file to address every possible requirement. A credentialing audit can be performed to determine whether: 

• All practitioners who provide care or services in a healthcare organization are properly credentialed and privileged
• Practitioners exercise only those privileges that they have been granted
• The process of credentialing physicians and other practitioners complies with federal and state laws and The Joint Commission and National Committee for Quality Assurance requirements
• The organization is in compliance with its own internal credentialing standards
• Methods are in place to ensure that all licensed independent practitioners are continuously licensed, have professional liability insurance, and maintain U.S. Drug Enforcement Agency registrations
• Adequate systems are in place to ensure that all practitioners are credentialed and reappointed within permitted time frames
• The organization is in compliance with the Health Care Quality Improvement Act and queries and reports to the National Practitioner Data Bank
• Evaluators make use of all information available when making recommendations to the organization’s governing board
   

This week’s tip is adapted from Credentialing Audits: Tools for compliance and reduced liability by Vicki Searcy, CPMSM.

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