The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more.
This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff and to understand why you must! Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also undergirds the reputation and credibility of the institution in the eyes of providers and across the healthcare community. Further, credentialing with insurers forms the basis for reimbursement for professional services. Without the acceptance of the professional credentials of a provider, insurers and other third-party payers will not compensate his or her claims. The purpose of this book is to explain the necessity and to provide the process for the official documentation of each practitioner. The information presented in these chapters will serve as a practical resource for strengthening your organization's credentialing function. = Book Features! -Outlines the necessity for credentialing in the delivery of care and in attaining reimbursements for services provided -Explores options for in-house and outsourced credentialing function -Provides systematic process for ongoing credentialing operations
Get the knowledge needed to serve as an effective Medical Executive Committee Member and fulfill the role well. The MEC Essentials Handbook breaks down the medical executive committee role to facilitate understanding of the responsibilities and strategies for being an exemplary committee member. Oftentimes physicians end up in a leadership position without really knowing what the job entails and what they are meant to accomplish. This handbook can be used as a comprehensive guide for physician leaders throughout their appointment, providing them with the necessary skills and knowledge they may not have received as part of their medical school training and residency. Plus, to make staff training easy, this handbook includes a customizable PowerPoint(R) presentation highlighting key takeaways covered in the handbook. Benefits of The MEC Essentials Handbook: Earn CE and certification credits Assess, document, and comply with The Joint Commission's core competencies Verify the competence of advance practice professionals and allied health professionals Understand the role of physician leaders in focused professional practice evaluation (FPPE), ongoing professional practice evaluation (OPPE), and peer review Overcome challenges presented by low- and no-volume providers and legal issues such as negligent credentialing Avoid costly, time-consuming fair hearings Oversee professional conduct and confront disruptive behavior What's inside: Compare and contrast the roles and responsibilities of the medical staff, management, and board Describe the dimensions of physician performance Explain the role of MEC as oversight for the credentialing and privileging committee Explain the role of MEC as oversight for the peer review, quality, and patient safety committees Describe the MEC's role in overseeing disruptive physician behavior, according to the law and Joint Commission standards Identify the seven factors of successful medical staff development planning Derive strategies to streamline MEC meetings Table of Contents Chapter 1: Roles and responsibilities of the medical staff, management, and board Chapter 2: The Power of the Pyramid: How to achieve great physician performance Chapter 3: The MEC's role in credentialing and privileging Chapter 4: The MEC's role in peer review, quality, and patient safety Chapter 5: The MEC's role in managing professional conduct Chapter 6: The MEC's role in strategic collaboration with the hospital Chapter 7: Effective MEC meetings
"The Army physician assistant (PA) has an important role throughout Army medicine. This handbook will describe the myriad positions and organizations in which PAs play leadership roles in management and patient care. Chapters also cover PA education, certification, continuing training, and career progression. Topics include the Interservice PA Program, assignments at the White House and the Old Guard (3d US Infantry Regiment), and roles in research and recruiting, as well as the PA's role in emergency medicine, aeromedical evacuation, clinical care, surgery, and occupational health."--Amazon.com viewed Oct. 29, 2020.
Physician Credentialing: A Guide for Physician Office Staff Veronica L. Rosas, CPCS Credentialing providers in a physician practice is a confusing and time-consuming process that can seem daunting to even the most seasoned professional. Between managing the credentialing of new physicians to the mandatory recredentialing that must be undertaken every few years, it is imperative that practice-based credentialing coordinators are on top of their game. Covering the credentialing process for both hospitals and managed care organizations, Physician Credentialing: A Guide for Physician Office Staff is a must-have, practical, and easy-to-read guide for credentialing coordinators and office managers, whether they are brand-new or experienced. The book walks readers through the required forms, provides suggested timelines, details documentation requirements, and offers tips for multitasking and organizational strategies to maximize efficiency. There is even helpful professional guidance, including information on certification, networking, and education. This resource will help you do the following: Utilize your time efficiently by knowing all the steps in the credentialing process Stay on top of credentialing in the physician practice Plan ahead to manage credentialing for new physicians while maintaining credentials for current providers Table of Contents Preface Part 1: Introduction Chapter 1: Introduction to Credentialing Chapter 2: The Credentialing Application Chapter 3: The Managed Care Credentialing Process Chapter 4: The Hospital Credentialing Process Part 2: Introduction Chapter 5: Credentialing the New Provider Chapter 6: Recredentialing and Reappointment Chapter 7: Managed Care Organization Contracts Chapter 8: Multitasking Chapter 9: Not All Healthcare Organizations Are the Same Chapter 10: On Your Own but Not Alone: Networking, Education, and Certification Conclusion Appendixes Appendix A: Contracting Checklist Appendix B: Acronym List Who should read this book? Credentialing coordinator Credentialing professionals Physician practice manager Physician office manager Physician practice administrator Practice manager Office manager Practice administrator Business manager
You should buy this book if: You are a corporate trainer seeking either an outline for training in Medical Staff Credentialing or looking to supplement your current training curriculum.You want to learn the Medical Staff Credentialing process on your own.Even if you have already done credentialing, but need either a refresher, or to learn parts of the credentialing process you may not know.You are considering Medical Staff Credentialing as a career move
Explaining how to develop a patient-centered medical tourism program, the Handbook of Medical Tourism Development is the ideal guide for any hospital, clinic, hotel, spa, or ancillary facility wishing to become a medical tourism provider. From high-cost surgery, transplants, diagnostics, and preventive wellness checkups, to medical and wellness spa retreats, patient follow up, and outcomes measurement, this book covers the gamut of related issues. Details the elements necessary for a successful system Addresses contracting issues likely to arise Includes access to additional resources on the book’s website Maria K. Todd prepares readers to build the medical tourism service line, integrate physicians and other service providers, develop a safe and effective quality and patient-centered infrastructure, document processes and workflows, determine pricing, evaluate reimbursement contracts, and measure outcomes. She offers useful nuts-and-bolts guidance on confidentiality, documentation, quality and safety, hospital accreditation schemes, revenue implications, and contracting. Sharing time-tested insights, the book will help readers avoid common pitfalls when working with U.S. and international health insurance companies, case managers, professional facilitators, and multinational employers. Read a recent a href="http://www.prlog.org/11757451-medical-tourism-expert-breaks-down-step-by-step-medical-tourism-program-development-for-providers.html " press release about the Handbook of Medical Tourism Program Development: http://www.prlog.org/11757451-medical-tourism-expert-breaks-down-step-by-step-medical-tourism-program-development-for-providers.html
The Medical Staff Handbook is the completely updated edition that provides an in-depth explanation of Joint Commission standards that address all medical staff issues, including the recently revised MS.01.01.01 standard. This reliable one-stop resource provides information on the credentialing, privileging, and appointment processes for hospital practitioners. The Medical Staff Handbook also includes the following: * An appendix with all Joint Commission Medical Staff standards, rationale, elements of performance, and scoring information * Complete coverage of medical staff bylaws and other areas affected by the revised MS.01.01.01 standard * Thorough interpretation of all Joint Commission standards related to the medical staff * Tips for developing new medical staff processes and improving existing processes for appointment and reappointment * Sample documents, practical strategies, and detailed examples to help readers understand and comply with the Medical Staff standards
