The United States District Court for the Southern District of Ohio Western Division (the “Court”) denied a hospital’s motion to dismiss a claim of negligent credentialing of an independent surgeon facing multiple federal charges. The motion to dismiss the negligent credentialing claim is one...
We began this series talking about “tribes.” As physicians, we belong to a very exclusive and circumscribed club of clinicians who inherently distrust anyone not a member of that tribe. In the hospital setting, this often plays out as “us” (the medical staff) versus “them” (the hospital...
Ever since the Harvey Weinstein scandal broke in 2017, there’s been new (and well-deserved) attention placed on sexual harassment, and healthcare organizations are no exception. The industry is rife with examples.
Credentialing Resource Center Journal - Volume 27, Issue 7
In managed care credentialing, delegation is defined as a formal process by which an organization gives another entity the authority and responsibility to perform certain functions on its behalf through a contractual arrangement. Delegation can provide many benefits to both organizations, but...
Credentialing Resource Center Journal - Volume 27, Issue 6
The difference between being accredited as a hospital or as an outpatient center can mean a difference of thousands of dollars in revenue when billing Medicare. And if you are a smaller, specialty hospital or an outlying facility that is part of a larger health system, be prepared: CMS and other...
Credentialing Resource Center Journal - Volume 27, Issue 5
In a 4-3 decision, the Supreme Court of Pennsylvania (the “Court”) recently affirmed a Superior Court decision to uphold a trial court’s ruling that limited the scope of the state’s Peer Review Protection Act (PRPA). The Court ruled that peer review documents are only protected by the PRPA if...
A working relationship with law enforcement is key to the safety, efficacy, and well-being of everyone in the hospital: providers and patients. That said, hospitals and law enforcement have different goals. And while the two usually work well together, they can find themselves at odds.
Credentialing Resource Center Journal - Volume 27, Issue 3
Avoid fair hearings at all costs. That is the advice of Heather Fields, JD, CHC, a shareholder at Reinhart Boerner Van Deuren, s.c., in Milwaukee. Reinhart has represented several hospitals and medical staffs during fair hearings and has seen the toll—both financial and emotional—that these...
State laws have established certain requirements for the licensing of healthcare practitioners and organizations. Beyond these exist various federal regulatory requirements, only some of which are tied to state or local law.
Credentialing Resource Center Journal - Volume 26, Issue 11
