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...
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...
Credentialing Resource Center Journal - Volume 26, Issue 11
Recruiting has become big business for hospitals and group practices. Having said that, the most damaging communication breakdowns often occur between recruitment and credentialing staff, costing the hospital and the candidate time, money, and dignity.
Credentialing Resource Center Journal - Volume 26, Issue 8
The U.S. District Court for the Northern District of Ohio (the “Court”) denied a plaintiff’s request to compel a hospital to disclose its incident reports during the discovery phase of a civil trial, finding the reports are protected by the Ohio’s peer review privilege.
Credentialing Resource Center Journal - Volume 26, Issue 4
