Credentialing is the foundation of any healthcare system as it ensures professionals are properly qualified, licensed, and experienced. The credentialing process presents many challenges, however, so training and consistent evaluation of the credentialing process is essential to preventing significant loss of time and resources. This series provides foundational credentialing and privileging training, as well as evaluates higher-level case studies and issues.

Learning Objectives:-

At the conclusion of this session, participants will be able to:

• Discuss and identify appropriate verification sources
• Identify and evaluate "red flags" in an application to identify potentially problematic practitioners
• Recognize the roles of various persons involved in the review and approval process for credentials files
• Discuss cases related to credentialing and privileging errors
• Examine why mistakes are made and understand how to avoid making credentialing and privileging errors

Session 1 — 90 Minutes, 10: 00 AM EST

Credentialing Basics

Session 2 — 90 Minutes, 11: 30 AM EST

Credentialing Basics

Overview:
These two sessions will provide an in-depth overview of basic aspects of credentialing, including primary source verification, applying criteria for appointment, reviewing the application for completeness, and roles in the review and approval process.

Objectives:
At the completion of these two sessions, participants will be able to:

• Track the credentialing process from application through governing body approval
• Define what constitutes a “complete” application
• Recognize the roles of various persons involved in the review and approval process
• Discuss primary source verification and which sources are appropriate
• Determine sources other than primary that can be utilized

Session 3 — 90 Minutes, 01: 00 PM EST

Privileging

Overview;
Having a comprehensive, criteria-based privileging system is an essential element of the medical staff’s role. The increased focus on quality by accrediting organizations, the government and the public emphasizes the need for continued monitoring of the quality of services provided, as well as having a strong privileging system.

Objectives;
At the completion of this program, participants will be able to:

• Recognize the importance of acquiring evidence to document competency
• Discuss the CMS and TJC requirements for privileging and documenting competency for privileges
• Discuss CMS regulations and TJC requirements for credentialing telemedicine practitioners in both acute care and critical access hospitals

Session 4 — 90 Minutes, 03: 00 PM EST

Identifying Red Flags in the Credentialing and Privileging Processes

Overview;
Identification of “red flags” or information that indicates there may be a problem that should be noticed or dealt with is an important step in the application process.  Some red flags are easy to identify, but others are more subtle. This program will discuss how to identify potential red flags, as well as the appropriate manner for following up on these issues.

Objectives;
At the completion of this program, participants will be able to:

• Discuss today’s “red flags” and how they differ from those of the past
• Discuss appropriate follow-up of information received in the application process
• Determine how to document medical staff evaluation of red flags

Session 5 — 90 Minutes, 05: 00 PM EST

Understanding Negligence in Credentialing

Overview;
This program will discuss the concept of negligence as it relates to credentialing and privileging. Past and recent negligent credentialing lawsuits, as well as their impact on the credentialing practices of the hospital, will be discussed.

Objectives;
At the completion of this program, participants will be able to:

• Define negligence as it relates to credentialing and privileging
• Recognize an organization’s duty to exercise due care in credentialing
• Discuss processes that may reduce the chance of a finding of negligence in credentialing

Who will Benefit:-

Medical service staff professionals, Credentialing specialists, Medical Directors, Vice presidents of medical affairs, Quality improvement professionals, Medical staff leaders, Credentials Committee members, and anyone involved with the credentialing and privileging functions