The
Credentialing and Privileges Manual is a unique
and important resource designed to assist hospitals, health plans and medical
groups in the design and implementation of exemplary credentialing and
privileging programs for physician and non-physician clinical
practitioners. It was developed as a tool for Credentialing Committee members
and credentialing staff who must perform this critical function in an organized, timely
and objective manner on behalf of the medical staff and governance body.
This
388 page updated manual is focused on credentialing issues, forms, and criteria for
credentialing, recredentialing and the granting of
privileges for primary and specialty physicians plus non-physician clinicians
(often called physician extenders, allied health professionals or midlevel
practitioners). Extensive and detailed example lists of privileges for each
specialty or clinician are included in an easy to use check-list format.
Resident competency guidelines by year of training resource links are included for most specialties.
Contents List
Preface - Introduction; Procedure credentialing vs core credentialing; Joint Commission bylaws and other credentialing requirements; Standard of care for credentialing and privileging processes; Document handling;
Credentials - Why credential?, Credentials Committee, Procedure credentialing vs. core credentialing; JCAHO Medical Staff By-laws requirements; Peer Review; Negligent credentialing; Economic credentialing; Bylaws and Credentials, Provider Credentials and Privileges - Policy and Procedures, Credentialing Processes, Recredentialing, Request for Provider Application - response letter, Request for Application, Application and related documents, Provider Release/Consent Form, Release of Insurance Information Form, Addendum to Provider Legal History Form, Applicant references; Evaluation Form/letter to send to applicant's references;, Application Process;
Working Document For Coordinators Use, Letters/Forms To Verify Internship/Residency Training, Provider Application Credentialing Form Check Lists, Provider Letter re: Required Documents Between Credentialing Cycles, Providers, DEA Certification form, ADA implications for medical staff privileges, Release of appointment application to hospital medical staff for use by PHO or another external organization, Monthly ‘Hot Sheet’ Review - recommendation; High Risk Providers, Provider Sanctions, Criminal background checks, Public Law Title IV (HCQIA), National Practitioner Data Bank (NPDB); Practitioner Health Status Request Letter, Primary Verification by State Medical and Dental Boards, Web Sites for Online Verification by State and Specialty Boards;
Voluntary resignation/Leave of Absence Policy; Adverse re-credentialing or privileges determinations - fair hearing; Suspension notes; Licensure Examination Scores – relation to quality of practice.
Interns, residents, preceptorships, other trainees
Peer (physician/physician and
physician/staff) Evaluations - Physician - Physician Evaluation Procedures and Forms,
Physician/Physician, Self-Evaluation and Physician/Staff Forms.
Privileges: Introduction to Privileging, Requirements for the granting of privileges, Staffing plan, Limited privileges, Temporary Privileges, Emergency/disaster privileges, Aging practitioners; Proctoring, Board Certification, Competency, Core privileges, Request for privileges to perform a ‘new’ procedure; Privileges signature sheet - form; Medical Executive Committee (MEC) Clinical Privileges Review and Recommendations - Form; Form to record granting privileges by Board; Volume considerations as a privileging criteria for procedures; Focused professional practice evaluation (FPPE);
Setting or Location for the Exercise of Surgical or Invasive Procedure Privileges; Monitoring Procedures Performed that Require Specific Privileges; Cross-Department Privileges by procedure (ECG interpretation, Swan-Ganz catheter insertion, vasectomy, sigmoidoscopy, hyperbaric oxygen therapy, amniocentesis, thoracotomy tube insertion and management, tympanocentesis, C-sections, endoscopies);
'On-call'
cross-departmental privileges, Processing Privileges,
Privileges Signature Sheet, Signature and Record Sheet for Granting Privileges,
Loss of privileges due to inactivity; Privilege requests for new technology,
devices or procedures
Delineation of Privileges - core and detailed privileges lists + criteria for each specialty or subspecialty -
*** e-mail apollomanagedcare@cox.net to obtain example pages for any topic of topic of interest ***
Anesthesiology: Core; Checklist + detailed privileging criteria for: Conscious sedation, Resident competency by year of training link; Pain management; Anesthesiology Proctor Assessment Form; Anesthesiology web links
Cardiovascular/Thoracic Surgery: Core criteria; Privileges checklist + resources
Critical Care: Core criteria; Privileges checklist + resources
Cross-departmental privileges - core criteria
Dentistry and Oral Surgery: Core criteria; Privileges checklist + resources + detailed privileging criteria for: Arthroscopy of the Temperomandibular joint,
Dermatology: Core criteria; Privileges Checklist + resource links
Disaster Medicine: Core criteria
Emergency Medicine; Disaster medicine: Core criteria; Privileges Checklist + resource links
Family
Hospitalists: General information. Credentialing and privileges based on specialty and current competence.
Internal Medicine Core criteria for privilege levels I, II, III, IV; Checklist + detailed privileging criteria for: Core criteria for Allergy and Immunology subspecialty III/IV privileges; Core criteria for Endocrinology and Metabolism subspecialty III/IV privileges; Core criteria for Infectious Disease subspecialty III/IV privileges; Core criteria for HIV privileges; Core criteria for Nephrology subspecialty III/IV privileges; Core criteria for Rheumatology subspecialty III/IV privileges; Core criteria for Pulmonary Disease subspecialty III/IV privileges; Example delineation of privileges forms online; Resident competency requirements
Cardiology/Cardiovascular Surgery Subspecialty III/IV procedure privileges criteria: Checklist + detailed privileging criteria for: Carotid endarterectomy; Cardiac Computed Tomography and Computed Tomography Coronary Angiography (CCTA); Direct current cardioversion, elective; Exercise treadmill test (Stress Test) privileges; Echocardiography, Stress Echocardiography privileges, references; Permanent pacemaker placement privileges; Impedance Cardiography; Percutaneous transluminal coronary angioplasty (PTCA) privileges; Cardiac catheterization; Intracoronary stent implant privileges; References for angioplasty, stents, cardiac catheterization; Percutaneous balloon valvuloplasty (PTV); Electrophysiology (EP), references; Cardiology/Cardiovascular procedure privileges - general references; Internal Medicine Web Sites - useful for credentialing;
Hematology/Oncology: Core criteria; Privileges Checklist + resource links
Neurology; Core criteria; Checklist + detailed privileging criteria for: Electrodiagnostic testing privileges with resource links;
Neurosurgery: Core criteria; Privileges Checklist + resource links
Nuclear Medicine: Core criteria; Checklist + detailed privileging criteria for: Nuclear Cardiology, I-131 Therapy with resource links;
Obstetrics/Gynecology: Core criteria; Checklist + detailed privileging criteria for: High-risk privileges; Obstetrical and Gynecological Ultrasound Examination Privileges; Laparoscopically Assisted Vaginal Hysterectomy, Colposcopy,
Occupational Medicine: Core criteria; Privileges Checklist + resource links
Ophthalmology: Core criteria; Privileges Checklist + resource links
Orthopedic Surgery: Core criteria; Privileges Checklist + resource links and Pediatric orthopedic surgery privileges
Otolaryngology/Head and Neck Surgery (ENT): Core criteria; Privileges Checklist + resource links
Pathology: Core criteria; Privileges Checklist + resource links
Pediatrics, Core criteria, Pediatrics, I, II, III, IV, V; Privileges Checklist + resource links
Physical Medicine and Rehabilitation: Core criteria; Privileges Checklist + resource links
Plastic and Reconstructive Surgery: Core criteria; Privileges Checklist + resource linkss
Podiatry: Core criteria; Privileges Checklist + resource links
Preventive Medicine/Public Health: Core criteria; Privileges Checklist + resource links
Psychiatry: Core criteria; Privileges Checklist + resource links
Behavioral Health Care Clinicians: Core criteria; Credentialing & Privileges: Checklists + detailed privileging criteria for: Psychiatry, Psychology, Psychotherapist, Psychology Associate or Assistant; Psychiatric Nurse Specialist (Advanced Practice Nurse); Medical Social Work; Medical Hypnosis/Hypnotherapy Privileges, Addiction Specialist - core criteria and checklist; Biofeedback Privileges, Neuropsychological Testing Privileges, Therapy: Family and/or Marital Privileges for Psychology,
Radiology: Therapeutic Radiology: Privileges checklist + detailed privileging criteria for: Diagnostic and Interventional Radiology (Criteria for Ultrasound Imaging, Cardiac Computed Tomography and Computed Tomography Coronary Angiography (CCTA); Discography, Core-Cut Breast Biopsy Privileges, MRI, Neuroradiologic Procedures, Neuroradiology Facility, Renal and Visceral Transluminal Angioplasty and Vascular Stenting, Peripheral and Visceral Arteriography, Arteriography/Angioplasty Facility, Kyphoplasty and Vertebroplasty; Percutaneous Nephrostomy,
Radiation Oncology: Core criteria; Privileges checklist + detailed privileging criteria + resource links.
Surgery: Core criteria; general: Checklist + detailed privileging criteria for: Bariatric Surgery criteria; Criteria for Endoscopic Cholecystectomy, Laser procedures (all specialties); Laparoscopic gastric bypass; and Pediatric general, transplant surgery privileges
Urology: Core criteria; Privileges; Privileges Checklist; Laparoscopic nephrectomy;Tension-free Vaginal Tape (TVT) Procedure; Percutaneous nephrostomy; Robotic assisted radical prostatectomy (RAP) and laser radical prostatectomy (LRP) procedures + resource links
Other: detailed privileging criteria for: Pain Management; Telemedicine services; Ventilator management; High Frequency Oscillatory Ventilation (HFOV) and other procedures; Long-term Care (LTC/SNF) Medical Directors & Physicians
Non-physician Clinicians or Allied
Health Professionals: Credentials and Privileges -
Introduction; Allied Health Professionals Staff
Application Form; Credentialing Criteria for Allied Health Professionals; Authorization/monitoring
of external agency or physician employees who provide healthcare services;
Allied
Health Professional Privileges Approval Sheet; Certification Statement by
Supervising Physicians.
Credentialing and Delineation of Privileges for Non-physician Clinicians by area of practice - Core criteria; Checklists + detailed privileging criteria for:
Audiologists; Blood bank technologist; Nurse Practitioners, Standardized Procedures for Nurse Practitioners (Immediate/Urgent care); Verification of critical care nurse competencies (form); Chiropractors; Doulas; Optometry; Pharmacist, clinical; Podiatrists
Behavioral health providers: Refer to the preceding list.
Physicians Assistant s (PA, Hospital-Related Services, PA, Ambulatory Care Privileges, PA, Notification of Privileges Form); Medical Assistant; Surgical Assistant;
Certified Registered Nurse Anesthetists (CRNA); Certified Nurse Midwives (CNM); CNM Job Description; Licensed Vocational Nurse (LVN/LPN), Scope of Practice; Registered Nurse, Scope of Practice; Case manager employed by another organization;
Nurse/Physician Assistant - Endoscopy; Case Manager (CM); Nutritionists; Physical Therapists; Occupational Therapists; Speech-Language Pathologists;
Ultrasound Technicians; Safety Officers; Cardiology technicians/assistants; Electrodiagnostic technicians; Volunteers; Therapeutic Yoga; Acupuncturists.
Provider Relations and Credentialing: Coordinator Position
Description; NCQA Credentials Verification Services Certification Criteria List.
Addenda
Community Health - Medical staff credentialing; Guidelines for Credentialing in Long-Term Care;
Credentialing Software and Services
-
lists of vendors and contact information.
Site visit or survey credentialing tool in a check-list format for physician offices and facilities plus an authorization and release form for medical office site visits; Joint Commission Office-based Surgery Standards Sampler;
Case law references for credentialing.
Web links related to medical staff bylaws, credentialing and the granting of privileges, performance appraisal, and peer review.
References and Resources - In addition to references and resources related to credentialing and privileges.
E-mail
Medical
Staff Peer Review
Contents List
q Medical Staff Services; Committees;
q Introduction
to Peer Review; Key requirements of the HCQIA of 1986; NPDB reports and queries;
State statutes; High risk providers - the impaired physician; Focused reviews;
Legal notes;
q Provider sanctions; Sanction levels;
q
Peer Review Plan; Confidentiality Statements;
Scoring System for Peer Review; Peer Review Committee minutes - example format;
Peer review confidentiality safeguards; Cautions regarding the peer review
process;
q
Physician/physician
or other professional colleague peer evaluation forms; Physician performance
evaluation process and forms; Santa Barbara Medical Foundation evaluation
program;
q
Quality
Assessment Review Forms; Physician Chart Review Profile Forms;
q Evaluation and Treatment Organizations - resource list
q
References
and Resources; Selected benchmark peer review case law references; Web site
links.
v Apollo’s ongoing commitment to you: We’ll promptly comment by e-mail on proposed privileges or other issues related to this manual for one year following purchase without a fee.
E-mail
Next steps
v To order - The price of the Credentialing and Privileges manual and CD is $275.00 plus $15.00 shipping and handling. The Health Care Provider Peer Review publication is $65.00 plus $5.50 shipping/handling. Order both manuals for $335.00 plus $15.00 shipping and handling or a total of $350.00. Prepayment by check, Visa or MasterCard is required.
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