Ask the expert: Do managed care organizations require that practitioners with whom they contract hold clinical privileges or membership at an accredited hospital?

In the past, managed care organizations (MCO) did not conduct practitioner performance evaluations or credential their practitioners. Instead, they required practitioners to hold medical staff membership and clinical privileges to ensure that they were qualified. Today, however, many MCOs do not require practitioners to hold clinical privileges or be on the medical staff of an accredited hospital. Routinely, MCOs are looking to provide patients with continuity of care.

This week’s question and answer are adapted from Assessing the Competency of Low-Volume Practitioners: Tools and Strategies for OPPE and FPPE Compliance, Second Edition by Mark A. Smith, MD, MBA, CMSL and Sally Pelletier, CPMSM, CPCS.