Credentialing & PrivilegingCredentialing & PrivilegingAn Overview for ApplicantsAn Overview for Applicants

Cheryl Schilke, RN, CPMSMCheryl Schilke, RN, CPMSM

Director, Credentialing ServicesDirector, Credentialing Services

Synernet CVOSynernet CVOAndAnd

Debbie A Hall, CPCSDebbie A Hall, CPCS

Medical Staff CoordinatorMedical Staff Coordinator

Maine Medical CenterMaine Medical Center

What is credentialing?What is credentialing?

Collecting information about education, Collecting information about education, training, experience, licensure, criminal training, experience, licensure, criminal actions, ability to get along with others actions, ability to get along with others and clinical competence (if privileges and clinical competence (if privileges requested).requested).

To the extent possible, this information To the extent possible, this information must be verified directly with the must be verified directly with the certifying organization or peers (Primary certifying organization or peers (Primary Source Verification or PSV)Source Verification or PSV)

Why is it necessary?Why is it necessary?

To protect the patientTo protect the patientRecommended reading: “Blind Eye: How The Medical Recommended reading: “Blind Eye: How The Medical Establishment Let A Doctor Get Away With Murder”Establishment Let A Doctor Get Away With Murder”

To protect the hospitalTo protect the hospital- - Maine State Regulations for the Licensing of Maine State Regulations for the Licensing of HospitalsHospitals- JCAHO and Magnet Hospital Accreditation standards- JCAHO and Magnet Hospital Accreditation standards- CMS requirements for participation in Medicare and - CMS requirements for participation in Medicare and Medicaid Medicaid- Risk Management- Hospitals may be liable for - Risk Management- Hospitals may be liable for negligent credentialing in malpractice casesnegligent credentialing in malpractice cases

Why does it take so long?Why does it take so long?Applicationsubmitted -reviewed for

completeness andconformance with

adminstrativecriteria

Primary SourceVerifcation (PSV)

Completed

Clinical Chiefevaluation

CredentialsCommittee

Review

Medical ExecutiveCommittee Review

Board of TrusteesApproval

PSV may take up to 45 days

Chief may require an interview, may contact peers directly by phone before completing a written evaluation – may take up to 30 days

If application incomplete, illegible or contact information not provided, may delay start of PSV

Credentials Committees generally meet once a month – may be 30 days until next meeting

Executive Committees generally meet once a month – may be 30 days until next meeting

Boards generally meet once a month – may be 30 days until next meeting

Total possible 165 days

Maine Uniform ApplicationsMaine Uniform Applications

Complete once (do not sign and Complete once (do not sign and date)– KEEP A COPYdate)– KEEP A COPY

For each submission, update as For each submission, update as necessary, photocopy, sign and date.necessary, photocopy, sign and date.

Form may be downloaded from:Form may be downloaded from:http://www.meamss.org/ http://www.meamss.org/

Select the application appropriate to your Select the application appropriate to your credentialscredentials

Completing the ApplicationCompleting the Application The application must be filled out legibly and The application must be filled out legibly and

completelycompletely. Answer . Answer everyevery question. If a question. If a particular section does not apply to you, mark it particular section does not apply to you, mark it N/A.N/A.

Provide complete contact information. Fax Provide complete contact information. Fax numbers and/or e-mail addresses are numbers and/or e-mail addresses are particularly important. particularly important.

Do not write “see CV” - all information must be Do not write “see CV” - all information must be on the application. Ensure that the CV and on the application. Ensure that the CV and information on application do not conflict. information on application do not conflict. Explain any gaps in professional history, from Explain any gaps in professional history, from completion of medical education, of greater completion of medical education, of greater than 60 days. than 60 days.

Supply all other names under which you Supply all other names under which you practiced or trained.practiced or trained.

Some of the information Some of the information requested is personal, must I requested is personal, must I

answer?answer? Social security number and date of birth are required Social security number and date of birth are required

because many verifying organizations use them for because many verifying organizations use them for identification.identification.

Hospitals are required by regulation to ask about your Hospitals are required by regulation to ask about your health and how it may affect patient care. The health and how it may affect patient care. The questions on the application do not ask for details, questions on the application do not ask for details, simply whether you require accommodation. You may simply whether you require accommodation. You may be required to provide more information later in the be required to provide more information later in the process.process.

You must divulge any sanctions or criminal convictions You must divulge any sanctions or criminal convictions on initial application. On reappointment, only new on initial application. On reappointment, only new actions since your last appointment must be reported.actions since your last appointment must be reported.

Home information is kept as confidential as possible. If Home information is kept as confidential as possible. If you have family privacy concerns, please consult the you have family privacy concerns, please consult the medical staff office.medical staff office.

What happens if I forget, omit What happens if I forget, omit or falsify information on the or falsify information on the

application?application?

Incomplete applications will not be Incomplete applications will not be processed.processed.

If it is determined that omission or If it is determined that omission or misrepresentation was intentional, misrepresentation was intentional, automatic denial of application or automatic denial of application or termination of membership and/or termination of membership and/or privileges may result.privileges may result.

Where Do You Begin?Where Do You Begin? Complete Maine Uniform Complete Maine Uniform

application once. Attach any application once. Attach any documents requested in documents requested in instructions and attach MMC instructions and attach MMC specific documents.specific documents.

Copy application for your Copy application for your records, THEN sign and mail. records, THEN sign and mail. This way, you can use the same This way, you can use the same application for other facilities.application for other facilities.

Submit promptly! Remember - Submit promptly! Remember - we can’t process it if we don’t we can’t process it if we don’t have it!have it!

Then...Then...

You can check in with You can check in with the Medical Staff the Medical Staff Office from time to Office from time to time. Please note that time. Please note that calling calling everyevery day does day does not help.not help.

You can nudge slow You can nudge slow references along.references along.

Submit updated DEA, Submit updated DEA, license and insurance license and insurance certificates as soon as certificates as soon as you receive them.you receive them.

The most important thing…The most important thing…

We can’t emphasize this enough We can’t emphasize this enough Submit earlySubmit early Make sure application is completeMake sure application is complete Attach all required documentsAttach all required documents

Your responsibility:Your responsibility:as applicantas applicant

To produce adequate information for To produce adequate information for a proper evaluation of experience, a proper evaluation of experience, ethics, background, training, ability ethics, background, training, ability to work efficiently and cooperatively to work efficiently and cooperatively with others, and suitability for the with others, and suitability for the clinical privileges and staff category clinical privileges and staff category requested requested

To remove any doubt about these or To remove any doubt about these or other basic qualifications for Medical other basic qualifications for Medical Staff membership Staff membership

To satisfy all requests for information To satisfy all requests for information

Your responsibility:Your responsibility:as a professional referenceas a professional reference

Be candid in your evaluation. Your Be candid in your evaluation. Your comments and identity will be comments and identity will be confidential to the extent possible.confidential to the extent possible.

Return reference forms promptly. Return reference forms promptly. Your peers will be grateful and will Your peers will be grateful and will return the favor.return the favor.

ReappointmentsReappointments

Why do I have to re-apply Why do I have to re-apply every two years?every two years?

Hospitals are required by law to Hospitals are required by law to appoint providers for no longer than appoint providers for no longer than 24 months.24 months.

Failure to reapply means Failure to reapply means membership and/or privileges simply membership and/or privileges simply expire and the provider may no expire and the provider may no longer provide hospital care after the longer provide hospital care after the specified date.specified date.

What Happens if I Turn In My What Happens if I Turn In My Reappointment Application Reappointment Application

Late?Late? Reappointment applications are subject to the Reappointment applications are subject to the

same verification and review process as initial same verification and review process as initial applications.applications.

The same time constraints apply with the The same time constraints apply with the added risk that the original appointment will added risk that the original appointment will expire before the process is complete.expire before the process is complete.

If the original appointment expires, a new If the original appointment expires, a new initial application must be completed and if initial application must be completed and if new membership criteria have been new membership criteria have been established since you joined the staff, you established since you joined the staff, you may no longer be eligible. may no longer be eligible.

Contact InformationContact Information

For questions related to application form: For questions related to application form: Cheryl Schilke, Synernet CVO, 771-3489 ext 1 Cheryl Schilke, Synernet CVO, 771-3489 ext 1 or or cschilke@synernet.netcschilke@synernet.net

For questions related to credentialing & For questions related to credentialing & privileging: Dyan Albano, MMC Credentialing privileging: Dyan Albano, MMC Credentialing Specialist 662-2828 or Specialist 662-2828 or alband@mmc.orgalband@mmc.org

For questions related to MMC Bylaws, Policies or For questions related to MMC Bylaws, Policies or Rules and Regulations, regulatory compliance:Rules and Regulations, regulatory compliance:Debbie Hall, Medical Staff CoordinatorDebbie Hall, Medical Staff Coordinator662-2828 or 662-2828 or hallda@mmc.orghallda@mmc.org