The managed care organization's (MCO) reimbursement policy and rates are a major factor when deciding whether to sign a contract to participate in its provider network. One of your duties may be to create a fee schedule comparison by setting up a spreadsheet that lists the top or most common CPT...

Practitioners’ scopes of practice are primarily established by the state, rather than the federal, government. Hospitals then determine allowed practice parameters within state boundaries. In other words, if a state has expanded the scope of an advanced practice professional’s (APP) practice,...

There is good protection for physicians who engage in peer review activities, such as legal immunity from damages under the Health Care Quality Improvement Act of 1986, which is often reinforced by similar state statutes. However, these statutes cannot keep lawsuits from being filed. Therefore,...

Prospective proctoring is a powerful and greatly underutilized tool. The approach involves a one-on-one discussion with the practitioner of concern to learn how he or she will tackle a specific patient care problem and to understand his or her clinical thinking. It is a vehicle for previewing...

Peer review ensures that a hospital assesses the performance of individuals granted clinical privileges via the activities of its medical staff, and uses the results of such assessments to improve care. This free resource is a sample form for documenting OPPE results from ...

Your clinical privilege forms need to be reviewed on a regular basis to ensure they reflect up-to-date criteria requirements and standards for the procedure or specialty in question. For example, a procedure that used to be considered a special, noncore privilege when you developed your forms...

One way to encourage physician proctoring is to make it a medical staff expectation—either informally through your culture or formally through your medical staff governance documents. At St. Jude Medical Center in Fullerton, California, the medical staff rules and regulations and bylaws make...

This checklist will help medical staffs select indicators for use in OPPE/FPPE. Indicators should be evaluated for validity, accuracy, benefits, attribution, communicability, competency, and data availability. Keep in mind that some indicators will be more relevant than others based on specialty...

This free resource comes from The Medical Executive Committee Manual. Since the leadership skill set is not routinely taught in the medical education process, the medical executive committee...

MSPs are often tasked with taking meeting minutes for medical staff committees, including the credentials committee. The compiler of the minutes sends them to the credentials committee chair for approval, and it’s most effective if this happens within a week of the meeting. Many MSPs write and...

Pages