To maintain Medicare billing privileges, a provider or supplier (other than a durable medical equipment, prosthetics, orthotics and supplies [DMEPOS] supplier) must resubmit and recertify the accuracy of its enrollment information every five years, a process known as revalidation.
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Bias is a common stumbling block to effective peer review. Bias can take a well-meaning committee that is truly focused on improvement and make it appear as if it is practicing sham peer review.
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...
One of the key challenges that low- and no-volume providers present is how to assess their competence when you have little or no data on their performance in your organization. Most medical staff leaders say it is difficult to get any information of real value from references today.
When addressing disruptive physician behavior, organizations must understand an often confusing phrase: zero tolerance. Many medical staffs are adopting a zero-tolerance policy with regard to disruptive behavior, but some hospitals are confused about what exactly zero tolerance entails. This...
The primary question a physician reviewer is trying to answer is whether a physician’s actions and decisions were appropriate independent of the care outcome. One of the main components of reviewing performance is identifying the key issues of the case. Physicians reviewers should ask themselves...
When physicians are given feedback data regarding outcomes, a common response is “My outcomes are worse because my patients are sicker.” This concern is legitimate and should be addressed by...
How often have you heard it said that a medical staff leader was selected because he or she was not at a particular meeting? If the physician had been present at that meeting, he or she would have likely declined the invitation to become involved with leadership for a number of reasons: lack of...
