The revenue cycle is made up of numerous functions spread across several departments. The following is an introduction to the department’s essential responsibilities.
Preregistration: The patient’s demographic information and occasionally some limited health history are...
Most states recognize a hospital’s duty to exercise reasonable care in granting privileges. Although the hospital is not automatically liable for a practitioner’s negligence, it can be held liable for negligent credentialing if the determination is made that a plaintiff’s injury would not have...
The onset of COVID-19 introduced significant credentialing challenges that healthcare organizations had not faced in prior emergency/disaster situations. What was different about the pandemic?
For one, it hit a large portion of the United States all at once; for another, it has lasted...
Prescription drug monitoring programs (PDMP) are state databases that track prescriptions for controlled substances. Both prescribers and pharmacists have access to PDMPs; in fact, pharmacists are required to enter filled prescriptions into PDMPs prior to dispensing, and in some states,...
Mary Barr, CPMSM, was new to her position as director of medical affairs at St. John Medical Center. With extensive experience as an MSP, Mary initially focused her attention on the scope of credentialing and privileging of current medical staff members, advanced practice professionals, and new...
The following figure provides some examples of physician indicators of performance that apply to the ambulatory setting. The Six General Competencies adapted from the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) joint...
Once a hospital has established which sites require practitioners to be privileged, the medical staff needs to evaluate the scope of services provided at the...
A key element that bylaws should address is the rights and due process that are to be afforded to medical staff members. This section could begin with a statement of member rights followed by an outline of initial collegial intervention and a progressive description of next steps when current...
Although it is important for the committee to review the entire credentials file, having a summary form with key elements can call attention to issues that require additional discussion. Suppose an applicant has had hospital privileges suspended, but he or she fails to note this fact on the...
When interviewing new applicants, it is often useful to use a structured interview form. This form should be modified to reflect the issues that are important to your hospital.
This allows the people conducting the interview to do the folloiwng, as well as so much more:
