Guest post by Donna Goestenkors, CPMSM, founder and president of Team Med Global Consulting, LLC

Donna GoestenkorsWe’re presenting a super webinar series on credentialing hosted by Donna Goestenkors, CPMSM, founder and president of Team Med Global Consulting, LLC. It’s called “Why Simple Credentialing is Smart: The Benefits of a Well Designed System”. She offered key recommendations for both the neophyte medical staff services professional (MSP) and the most well versed MSP on building an effective results-driven credentialing system. Here is her post packed with great tips.

We began our series with the topic, Build your Credentialing Process Framework and in the webinar, we offered a wealth of information. Yet, that doesn’t mean your credentialing system needs to be complicated. Keep things simple! Here are 7 simple steps to building a powerful, effective credentialing system:

    1. Communicate the “why” of credentialing. Before you create a new or revised credentialing system, tell your MSP’s why it’s important to credential. It’s really all about making sure you appoint or hire the best doctors – so that they will provide only the best care to patients. It’s also about protecting your facility from damaging malpractice lawsuits. Don’t just let your credentialing professionals go through the motions.
    2. Get to know the rule-makers and the rules. Before building your framework, educate yourself on the regulations and accreditation standards by which you must abide. Two main sources of rules: federal government regulations which includes the Centers for Medicare and Medicaid Services (CMS) and state laws. If your organization is reimbursed by the government, adherence to the CMS Conditions of Participation are required. Again, those regulations were created to ensure good doctors get appointed to the Medical Staff…and patients get good care. Check out these additional accreditation bodies for applicable standards that may accredit your organization’s credentialing, privileging, performance improvement and governance practices:
      • TJC (The Joint Commission)
      • HFAP (Healthcare Facilities Accreditation Program)
      • DNV GL (formally, Det Norske Veritas Global)
      • NCQA (National Committee for Quality Assurance)
      • AAAHC (Accreditation Association of Ambulatory Health Care)
    3. Match credentialing processes to your environment. Are you credentialing on behalf of a hospital, a university academic center, a critical access facility or a specialty hospital? It’s important to create your credentialing framework according to your organizational situation. It matters because there are different rules for different types of environments. For example, at hospitals, you need to consider medical staff bylaws, rules & regulations, policies and procedures, as well as standards laid out already by accreditation bodies, i.e. The Joint Commission’s Credentialing Standard – a 16-point guide to savvy credentialing. At managed care organizations (MCOs), consider your contracts and policies and procedures, too, but also incorporate guidelines set by the NCQA, which accredits MCOs.
    4. Align rules. Make sure your credentialing rules and processes at least match industry standards. Then, work on finding contrary processes, gaps, areas of redundancy, and forms that need revising or further development. From there, you can propose new processes, forms and procedures.
    5. Make sure your process improvement plan is comprehensive. It should include:
      • Current forms (so you can compare what you’ve got now to the improved documentation you plan to create)
      • Proposals for recommended changes
      • Rationale for your recommendations, including:
          i. Improved compliance
          ii. Best practices
          iii. Increased efficiency
          iv. Facility MS leadership preferences
          v. Requests from administrators
    6. Vet your plan. Seek comment and input from your peers and leadership to make sure your plan is truly comprehensive. Some folks to check with:
      • MSPs (Medical Staff Services Professionals), Management, directors, and credentialing committee – if you’re operating in a hospital
      • MSP team and external clients – if you’re a credentialing verification organization (CVO)
      • Medical staff services team, medical director and credentialing committee – if you’re a managed care organization
    7. Automate! It’s also a smart idea to automate your credentialing processes because automation nets faster, more complete information. Your best bet is cloud-based software that allows peer references access to online links to fill out information – versus faxing or emailing forms that need to be downloaded and filled out. Such systems mean you get reliable, accurate information in a matter of a few days, rather than the industry standard of 4-5 weeks.

Goestenkors is the industry go-to person on this topic, and in the webinar series, she crystallized why credentialing is more important than ever in today’s healthcare environment. Stay tuned for our next webinar, or find whitepapers and other information at www.skillsurvey.com/credential-ondemand.

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