Meeting accreditation standards
The work that MSPs do has high stakes, say authors Carol S. Cairns, CPMSM, CPCS, and Kathy Matzka, CPMSM, CPCS, in Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth Edition. The following excerpt from this robust guide explains why.
The Centers for Medicare & Medicaid Services’ (CMS) Conditions of Participation (CoP) contain minimum requirements that all hospitals that wish to provide services to Medicare or Medicaid patients must meet.
There are also accrediting bodies with minimum “standards” that must be met in order for a healthcare organization to be voluntarily accredited by that body. These accrediting bodies must submit their standards to CMS, which then reviews the standards for compliance with CMS’ CoP. If the standards meet or exceed the CMS regulations, the accreditation program is given “deemed” status. This means that healthcare organizations can participate in this voluntary accreditation in lieu of the state agency survey. In many cases, accreditors have more stringent standards than those required by CMS regulations.
With this in mind, one of the highest-risk procedures performed in a healthcare organization is not performed in an operating room, delivery room, GI laboratory, or emergency room. Nor does a surgeon, pediatrician, or family practitioner perform this high-risk procedure.
The procedure is credentialing, an activity that is performed in medical staff offices, provider relations departments, and credentials verification organizations (CVO) across the country. Regardless of the size or type of the organization, credentials specialists, healthcare facilities and physician leadership, health plan executives, and governing bodies share the medical and legal responsibilities and accountability to conduct a thorough, comprehensive, and timely credentialing process. The process includes verification, documentation, and approval of a practitioner’s credentials to practice in a healthcare facility and/or to participate in a managed care plan.
Source: Verify and Comply: Credentialing and Medical Staff Standards Crosswalk, Sixth Edition, which covers credentialing and medical staff standards and regulations, answering all MSPs’ accreditation questions in one easy-to-navigate manual. This latest and most expansive edition of HCPro’s popular resource includes ambulatory care, acute care, and managed care standards for the most prominent regulators and accreditors: CMS, The Joint Commission, NCQA, DNV, HFAP, and AAAHC.