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Health Care Credentialing: A Guide to Innovative Practices

Health Care Credentialing: A Guide to Innovative Practices by Fay A. Rozovsky, Christina W. Giles, Mark A. Kadzielski

Health Care Credentialing: A Guide to Innovative Practices

Contributor(s)
By Fay A. Rozovsky, Christina W. Giles, Mark A. Kadzielski
Update Frequency
Updated annually
Last Update
06/01/2016
Product Line
Wolters Kluwer Legal & Regulatory U.S.
Available formats

Details

Health Care Credentialing, takes you far beyond the standard review of credentialing concerns, delivering insights into innovative ways to collect, process and assess credentialing information. No matter where you're conducting credentialing, this resource will help you keep pace with the latest ideas and approaches.

Specifically, Health Care Credentialing will help you:

  • Take into account complex laws, regulations, and accreditation standards as they apply to credentialing
  • Handle disruptive care and clinical competency issues
  • Access information for evaluating core competencies to be used in credentialing
  • Stay up-to-date on relevant regulations, statutes, and accreditation standards

Health Care Credentialing helps you address the critical issues in this important arena. This unique resource delivers:

  • Coverage of credentialing for disaster management
  • Innovative processes to upgrade clinical competencies outside the credentialing system
  • Guidance on Board and IRB credentialing
  • Innovative perspectives to address behavioral problems and disruptive individuals
  • Cutting-edge approaches to "Pay-For-Performance" and credentialing
  • Ahead-of-the-curve insights into credentialing and federal requirements such as the ADA Rehab Act Section 504 and EEOC guidance

In addition, Health Care Credentialing will help you:

  • Keep pace with credentialing standards and relevant state and federal requirements
  • Launch important credentialing initiatives
  • Implement alternative programs to address emerging credentialing issues
  • And much more!

Health Care Credentialing includes updated discussions of:

  • Accreditors to include Center for Improvement in Healthcare Quality (CIHQ)
  • The influence of Internet information on credentialing
  • Further guidance on the Section 1921 enhancements to the National Practitioner Data Bank (NPDB)
  • The relationship of mid-level practitioners to the health care facility
  • Utah and the tort of negligent credentialing
  • The credentialing of aging physicians
  • Contemporary credentialing practices for providers of behavioral health and abortions
  • The importance of a provider's clinical competency in consent and shared decision-making in the credentialing process
  • And more!

ISBN: 9780735564824
Pages: 434
SKU: 0735564825
ETA: Available: Item ships in 3-5 Business Days
  • 1. CONTEMPORARY CREDENTIALING PROCEDURES
    • Influence of Accreditation Requirements
    • Credentialing in Transition with the Joint Commission
    • Influence of the Centers for Medicare and Medicaid Conditions of Participation
    • Influence of DNV (NIAHOSM) - A New Accreditation Source
    • Influence of Information on the Internet
    • Influence of Private Payers
    • Exhibit 1-1 Accrediting/Certifying Agency Programs
  • 2. CURRENT CREDENTIALING PRACTICES
    • The Two-Year Cycle
    • The Effect of the Health Care Quality Improvement Act of 1986 on Current Credentialing Practices
    • The Effect of the Americans with Disabilities Act and the ADA Amendment Act of 2008 on Current Credentialing Practices
    • The Effect of Section 504 of the Rehabilitation Act of 1973
    • The Effect of the Equal Employment Opportunities Commission Guidelines and Rulings on Current Credentialing Practices
    • Peer Review, Evidentiary Protection, and Credentialing
    • Mid-Level Practitioners
    • The Effect of State Law
  • 2A. LOOKING THROUGH THE PRISM OF CASE LAW: CONTEMPORARY CREDENTIALING PRACTICES
    • Significant Case Law
    • Centralization of the Credentialing Process
    • The Advent of "Patient Credentialing"
  • 3. WHY SYSTEMIC CHANGE IS NEEDED
    • Patient Safety
    • Pay-for-Performance
    • Ready Access to Data - Health Care Is "On Notice" of Potential Problems
    • Consumer Expectation
    • The Joint Commission's Credentialing Program
    • Inroads on Contemporary Credentialing Practices
    • The Burgeoning Cadre of Who Should Be Credentialed
    • Competencies
  • 4. EXAMPLES OF SUCCESSFUL CHANGE
    • Citizen Advocacy Programs
    • CPEP
    • The Vanderbilt Model
    • Elements of Successful Programs
    • Exhibit 4-1 PREP Documents, the California Board of Nursing
    • Exhibit 4-2 Memorandum of Understanding
    • Exhibit 4-3 North Carolina Process When PREP Referral Is Received
    • Exhibit 4-4 PREP Eligibility Criteria
    • Exhibit 4-5 Assessment: Practitioner Remediation and Enhancement Partnership
    • Exhibit 4-6 Procedure for Identification and Referral to the PREP Pilot Program
  • 5. MODELS FOR INNOVATIVE CREDENTIALING
    • Competencies-Based Credentialing
    • Collaborative Care Credentialing
    • Data-Driven Credentialing
    • Behavioral Change–Based Credentialing
    • Accountability-Based Credentialing
    • Credentialing Care Providers with Anger Management Issues
    • Credentialing Care Providers Recovering from Substance and Alcohol Abuse
    • Disaster Preparedness and Credentialing
    • Exhibit 5-1 Comparison of Four ABMS Specialty Board Maintenance of Certification Programs
    • Exhibit 5-2 Self-Assessment Questionnaire Items
    • Exhibit 5-3 Sample "Zero Tolerance" Policy
    • Exhibit 5-4 Applying for a Federal Job
  • 6. A PRIMER ON INNOVATIVE CREDENTIALING
    • The Retooled Application Process
    • Screening and Verification of Credentials in All Health Care Organizational Settings
    • The Demonstrated Competencies for Credentialing
    • Resident and Fellow Credentialing
    • Physician Ranking and Credentialing
    • Exhibit 6-1 Sample Release Language
    • Exhibit 6-2 Sample Authorization and Release of Information Form to Accompany an Application for Appointment/Privileges
    • Exhibit 6-3 Sample "Fair Notice" Language in the Letter to the Reference
    • Exhibit 6-4 Areas of Expertise Matrix Credentialing Chart for IRB
  • 7. BEHAVIORAL ISSUES AND CRENDENTIALING
    • Anger and Impulse Behavior
    • Other Types of Abhorrent Behavior
    • Known or Suspected Substance or Alcohol Abuse
    • The Importance of Decisive but Prudent Action
    • Use of Diversion Programs
    • Behavioral "Contracts"
  • 8. CREDENTIALING: LOOKING TO THE FUTURE
    • Risk Managing the Credentialing Process
    • The Need for Board Credentialing
    • Considering New Competencies for Clinicians
    • Systems Check: An Ongoing Process for Incorporating Accreditation, Legislative, Regulatory, and Case Law Changes
    • National Credentialing
    • Team Credentialing
    • Conflict of Interest Credentialing
    • Peer Reviewer Credentialing
    • Exhibit 8-1 Risk Management Credentialing Criteria Tool
    • Exhibit 8-2 Board Credentialing Criteria
    • Exhibit 8-3 Board Application and Screening Tool
  • APPENDICES
    • Appendix A Checklist for Initial Appointment
    • Appendix B Credentials Standards
    • Appendix C Physical and Mental Health Cover Letter and Forms
    • Appendix D A Pocket Guide to Credentialing for Medical Staff Membership and Hospital Privileges
    • Appendix E Fact Sheet: An Overview of PDS Prototype
    • Appendix F Final Rule for Section 1921
    • Appendix G Questions and Answers About Health Care Workers and the Americans with Disabilities Act
    • Appendix H Professional Conduct
    • Appendix I Designing a Credentialing Process for Live Organ Donor Advocate and Live Organ Donor Advocacy Team
    • Appendix J Sample Physician Feedback Questionnaire
    • Appendix K Medical Peer Review - Risk Management Strategies
    • Appendix L AETNA Agreement Concerning Physician Performance Management, Reporting and Tiering Programs, Attorney General of New York
    • Appendix M Joint Resolution, International Emergency Management Assistance Memorandum of Understanding, 2007
    • Appendix N IRS Form 990, Schedule H, Hospitals, for Tax Year 2009
    • Appendix O Excerpt from the Federal Rules of Civil Procedure: e-Discovery
    • Appendix P Form 35. Report of Parties' Planning Meeting
    • Appendix Q Sample Peer Reviewer Credentialing Tool
    • Appendix R Memorandum Report: Adverse Events in Hospitals, OEI-06-09-00360
    • Appendix S Protecting the Force: Lessons from Ft. Hood, Independent Review Board Report, January 2010
  • Table of Cases

$459.00