Webinar: Thursday, May 23 rd, 2013 Darlene Nicgorski, MS Ed, PHR Independent Consultant

Webinar: Thursday, May 23 rd, 2013 Darlene Nicgorski, MS Ed, PHR Independent Consultant

To provide an overview of a new resource to promote effective credentialing To increase health center staff and board members understanding of credentialing and privileging processes To encourage participants to submit their own tips

Process of assessing and confirming the qualifications of a licensed or certified healthcare practitioner. All HC practitioners: employed, contracted, volunteers and locum tenens

Patient Safety Risk Management Quality Improvement FTCA/HRSA State Laws Accreditation Organizations Private Insurance Companies

Deeming/Application Questions: BPHC helpline at 1-877-974-2742 or BPHChelpline@hrsa.gov Requirements (FTCA, HRSA) PIN 2002-22 PIN 2001-16 PAL 2013-5 The Joint Commission/AAAHC Staff to be Credentialed Licensed Independent Practitioners LIPs Other Licensed or Certified Practitioners OLCP

Before the hire date Application given or sent to appropriate candidates well in advance of hire date NO PROVIDER SHOULD BE ALLOWED TO BEGIN EMPLOYMENT UNLESS THE FILE IS COMPLETE STOP 6

Emergency Situations Not the Norm All verifications, checks, queries completed Missing the Board Approval & Urgent Need Time 30 days max Other ways to handle this Executive meeting of Board Conference call with the Board 7

Organizing Staff Roles and Responsibilities Requesting Information from applicants Organizing Credentialing Information

Identify a staff person to be the focal point Select a credentialing committee Don t reinvent the wheel, many sample applications available, etc. Maintain a checklist to manage receipt of documents

Identify a staff person to be the focal point of credentialing Select a committee: Who, When, What? Audit each file annually to identify missing items Update procedures as needed Educate the BOD regularly as to their role

Verifications assure quality Request an original professional license then verifications happen online Verify board certifications Verification of relevant education/training & experience Current competency and health fitness Request government issued photo ID

Maintain a copy of the original license in the practitioner s file Verify all licenses online with the appropriate licensing authority Verify specialties with boards online The American Medical Association (AMA) is considered primary source for verification. Great for medical personnel but not FNPs, Dentist, etc.

Spreadsheets for tracking to be in Excel per HRSA Create several spread sheets: LIP s and OLCP. They can be merged for your FTCA applicant list and include a place for date and initials The Professional/Peer Evaluation Form verifies the competence of the practitioner Attach a photo copy of the government issued ID to each Peer Evaluation form

Most health centers include Health Status and Fitness for Duty as part of credentialing application The query with the NPDB should include enrolling the provider in the Proactive Discloser System (PDS)

Last Name First Name Job Title Profess ional Design aton Status Date of Hire Current Credentialing Date Next Credentialing Date Adams Thomas Medical Director MD FT 11/1/2001 5/22/2012 5/22/2014 Jones Susan Physician MD PT 7/30/2009 7/1/2011 7/1/2013 Frank Sarah Dentist DDS FT 6/25/2012 6/8/2012 6/8/2014 Trent JoEllen Pediatrician MD Contract 9/30/2007 9/30/2011 9/30/2013 Stanton Sam Care Manager LCSW FT 11/29/2000 11/20/2010 11/19/2012

Checklist of materials needed from providers Checklist of queries and dates completed Sign off Checklists for Board IMPORTANT

Primary: verification by the original source Secondary: verification by sources other than primary PIN 2001-16 has a useful chart comparing required type of verification for LIPs vs OLCPs

The authorization to perform specific services within the training and competence of the practitioner And within the scope of services of the FQHC The Board of Directors grants privileges with the review and recommendation of the CMO, CDD, etc.

Lists specific services offered by LIP s Reviewed and recommended by CMO, CDO, etc. OLCP not approved by the BD but reviewed by supervisors

Different forms for each disciple and specialty Format: 4 columns for each service, requested, not requested, approved and not approved Policy on training & competence in new services Include verifying privileges and medial staff membership at local facilities per organizations requirements

Re credentialing and Privileging to be done Peer review important quality improvement measure built into this process CME (Continuing Medical Education) Required Board Approval required again and dates to be before 2 year expiration of last approval

Tracking sheets should have process set well in advance of the next BD s meeting Enroll all providers in the PDS (Proactive Disclosure System) of NPDB Check that BOD s meeting is an earlier date than two years or move up the date for board approval to earlier meeting EMR allows great opportunities for objective peer review

NACHC HR Clearinghouse ECRI has great credentialing webinars and resources Some PCA s have resources available or an HR Group statewide that shares resources This resource is a living document

We have lots of time left for your questions