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Identifies key responsibilities of the hospital, the organized medical staff, and the medical staff executive committee and governing board in granting and reviewing clinical care credentials and privileges. This title also provides examples for improving compliance.
This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff and to understand why you must! Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also undergirds the reputation and credibility of the institution in the eyes of providers and across the healthcare community. Further, credentialing with insurers forms the basis for reimbursement for professional services. Without the acceptance of the professional credentials of a provider, insurers and other third-party payers will not compensate his or her claims. The purpose of this book is to explain the necessity and to provide the process for the official documentation of each practitioner. The information presented in these chapters will serve as a practical resource for strengthening your organization's credentialing function. = Book Features! -Outlines the necessity for credentialing in the delivery of care and in attaining reimbursements for services provided -Explores options for in-house and outsourced credentialing function -Provides systematic process for ongoing credentialing operations
The Medical Staff Handbook is the completely updated edition that provides an in-depth explanation of Joint Commission standards that address all medical staff issues, including the recently revised MS.01.01.01 standard. This reliable one-stop resource provides information on the credentialing, privileging, and appointment processes for hospital practitioners. The Medical Staff Handbook also includes the following: * An appendix with all Joint Commission Medical Staff standards, rationale, elements of performance, and scoring information * Complete coverage of medical staff bylaws and other areas affected by the revised MS.01.01.01 standard * Thorough interpretation of all Joint Commission standards related to the medical staff * Tips for developing new medical staff processes and improving existing processes for appointment and reappointment * Sample documents, practical strategies, and detailed examples to help readers understand and comply with the Medical Staff standards
A criteria-based core privileging system ensures consistency, flexibility, efficiency, and objectivity. However, transitioning to core privileges can be a daunting and overwhelming task. Criteria- Based Core Privileging: Guide to Implementation and Maintenance helps take the hassle out of that transition. Acting as a how-to guide, this book provides the necessary steps for medical staff and credentialing leaders to successfully adopt a criteria-based system. In addition, it also lays out a road map to overcome the biggest challenges along the way, including obtaining buy-in from physicians and hospital leaders. This book will help medical staff leaders: - Develop a criteria-based core privileging system that is flexible, efficient, consistent, and objective - Identify key tips on how to obtain staff buy-in - Identify a clear path of transition to criteria-based privileging - Discuss how to apply criteria-based privileging to various practitioner categories - Handle privileging requests for new procedures and technology
MSPs and medical staff leaders do enough vetting for practitioner applications without worrying about tracking down and validating resources that support structurally sound credentialing and privileging processes. Featuring an array of field-sourced, expert-endorsed forms that facilitate regulatory compliance, policy development, and routine credentialing communications, The Credentialing and Privileging Toolbox lightens the administrative load so MSPs and medical staff leaders have more time for duties that foster high-quality care and patient safety. Inspired by our popular OPPE and FPPE toolboxes, The Credentialing and Privileging Toolbox offers a bevy of sample forms, policies, letters, plans, reports, and related resources that healthcare organizations of various scope, size, and service focus are currently using to execute effective practitioner vetting processes. Included tools, which come from in-the-trenches MSPs and medical staff leaders, have been curated and appraised by expert author Merella Schandl. The resulting collection reflects industry best practices, the wide range of modern healthcare entities that credential and privilege practitioners, and the various aspects of a successful vetting approach. Tools are arranged by type and topic for easy navigation. Within each tool, Schandl highlights key components and provides targeted analysis on tailoring the sample to individual facility needs.
This book addresses the wide range of issues that face the program leader – from how to choose a site and how to negotiate for equipment, to how to determine staffing requirements and how to anticipate and defuse possible turf issues with other programs and services in the hospital or healthcare facility. The early chapters of this book focus on the leadership of your program whether in your department or institution. The second section centers on education at all levels recognizing that smaller machines have made ultrasound available for medical students to advanced practitioners. The third section provides detailed logistics on equipment, maintenance, and safety. The fourth section focuses on a quality improvement program and includes a chapter on the workflow process. For those with limited budgets we also offer a section on practical operating and educational solutions. The fifth section offers insight into hospital level credentialing, quality assurance, national politics, and recent issues with accreditation. This is followed by reimbursement and coding. The last section covers topics in specialized communities. Chapters focus on ultrasound in global health, emergency medical services, pediatrics, critical care, community and office based practices. Multiple US working documents including checklists, graphs, spreadsheets, tables, and policy appendices are included.