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Archive November 2016 XVII, No. 11

Business Advisor: Get Your Credentialing Files in Order

10 tips to streamline your physician credentialing process.

Leslie Mattson

Leslie Mattson, RN, BSHM

BIO

maintaining credentialing files ALL ZIPPED UP Maintaining credentialing files appropriately is a time-consuming, detailed process.

If you do your own credentialing, you know it can be a job in itself. Not only is it a challenge to keep up with the regulations and make sure everything is current, but then it's time to re-credential before you know it. But with good preparation and a little creativity, your files can be organized and survey-ready, and contain all the necessary and up-to-date documents. Whether you're the one maintaining your credentialing files or supervising those who do, here are some tips I wish someone would have shared with me.

Prepare a request document for applicants. This document lists everything applicants will need to provide. E-mail it to surgeons and attach facility documents they'll need to complete, including a confidentiality agreement, a Hepatitis B requisition/declination form, and any policies or documents they may need to review. Include a by-laws attestation statement as part of your application process for the potential credentialed staff to sign. It shows that the applicant understands the facility by-laws and agrees to abide by them. Also include a permission slip/waiver for applicant signature so you can run all your checks.

Run your checks. As part of your due diligence, verify all licensure and certifications, both initially and during renewal. Primary source verification has 4 ingredients: a state license check, American Medical Association, National Practitioner Data Bank (NPDB) and Office of Inspector General (OIG). Run all the checks and print verifications. When you enter your applicant into the NPDB, set him up for continuous query so that you're alerted to any changes immediately. This also saves a new query at re-application. Save NPDB e-mails to support your process. An OIG check (exclusions.oig.hhs.gov) ensures there are no Medicare sanctions assigned to your applicant.

Maintain a current photo ID in each file. Replace the copies as they expire.

Check your applicant's insurance. Verify that it meets liability limits and minimums as defined in your facility's by-laws.

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