PSV of Credentials (#1)

Question 1

Do Demographics need PSV?

Answer 1

No.

Question 2

Education

Answer 2

PSV REQUIRED IN HOSPITAL SETTING
CoP: Criteria are character, competence, training, experience and judgment (CCTEJ)
TJC: Verification can come from: school, AMA, CVO, ECFMG, AOA, AAPA (PA)
HFAP: PSV required: AMA, AOA, ECFMG; documented training sufficient for privileges
DNV: PSV required on initial appointment, can come from: AMA Masterfile, ECFMG
NCQA: Must PSV highest 3 levels of education, 5th Pathway must be verified with AMA, PSV can come from: medical school, AMA Masterfile, AOA, ECFMG, FSMB for closed programs, state licensing agency if it performs PSV
URAC: Time limit: 6 months, verify highest level of education/ training, not required if board certified, state licensing board acceptable if it performs PSV, PSV can come from school/ training program
AAAHC: PSV on initial appointment

Question 3

Training

Answer 3

CoP: CCTEJ
TJC: Required- Program, AMA, AOA
HFAP: Required- Program, AMA, AOA; documented training sufficient for privileges
DNV: Required- AMA acceptable
NCQA: Required- AMA, AOA, FCVS for closed programs
URAC: Required- Time limit= 6 months, state licensing board & training program acceptable
AAAHC: Required at initial

Question 4

Work History

Answer 4

CoP: Not addressed, experience required
TJC: Evaluate termination of privileges
HFAP: PSV work history
DNV: Not addressed
NCQA: PSV not required; 5 years work history required; if <5 starts at initial licensure; 365= MCO, 305= CVO
URAC: Not addressed
AAAHC: Verifying admitting privileges

Question 5

Board Certification

Answer 5

TJC: PSV required at initial appointment, ABMS or AOA allowed
HFAP: Privileges cannot rely solely on board certification, ABMS or AOA allowed
DNV: Hospitals cannot rely solely on board certification
NCQA: Time limit: 180 days, if provider claims to be board certified, must PSV, verify at recredentialing if additional certification obtained, ABMS, AOA, AMA Masterfile
URAC: 6 months, verify board certification or highest level of education, required for initial credentialing only, unless certification expires, AMA, AOA
AAAHC: Verify on application & ongoing basis

Question 6

What is a license?

Answer 6

The authority a government agency grants an individual to practice a profession

• Regulation of medical & other professional practice is a state function
• Some states issue a controlled substance license, should be PSV if applicable
• Current, unrestricted licensure should be verified for all licensed providers

Question 7

Licensure

Answer 7

CoP: All staff required by the state to be licensed must possess a current license
TJC: PSV at initial, recred, expiration, must evaluate challenges/ sanctions /disciplinary actions
HFAP: PSV of current license, for telemedicine: dually licensed
DNV: PSV @ initial & recred
NCQA: PSV; Time limit: 180 days (120 for CVO)
URAC: Time limit: 6 months, PSV licenses on app, sanctions/ disciplinary actions <5 years reviewed; can use NPDB
AAAHC: PSV on initial & ongoing monitoring

Question 8

DEA

Answer 8

Issued to anyone who prescribes controlled substances, CSA (Controlled Substances Act) database authorized to provide proof of registration
TJC: Evaluate any challenges
HFAP: Evaluate any challenges
DNV: PSV per bylaws, mandate possible suspension if DEA revoked
NCQA: No time limit, must PSV @ initial & recred, vision inspection sufficient
URAC: PSV, 6 month time limit
AAAHC: PSV @ initial & Recred

Question 9

Professional Liability

Answer 9

HFAP: PL required
DNV: Possible suspension if provider minimums not met
NCQA: Required; 180 (120); Federal tort coverage- copy & attestation required
URAC: Required
AAAHC: Organization decides if required

Question 10

Criminal Background Checks

Answer 10

If state or organization requires background check; auditors will expect to see it
HFAP: Application must request information on criminal history

Question 11

Health Status/ Ability to Perform

Answer 11

ADA prohibits discrimination
TJC: Required; verification on initial
HFAP: Required; verification from PR
NCQA: Required; DQ
URAC: Required; DQ
AAAHC: Required

Question 12

Nondiscrimination

Answer 12

Civil Rights Act of 1871 prohibits unlawful employment discrimination
Cannot discriminate

Question 13

Peer Recommendations

Answer 13

CoP: CCTEJ
TJC: Required for initial & term considerations
HFAP: Initial requires 1
DNV: Initial requires 2
AAAHC: Required for initial & reappointment

Question 14

Medicare/ Medicaid Sanctions

Answer 14

HFAP: Requesting on application
DNV: Bylaws allow for suspension of privileges due to termination or revocation
NCQA: Ongoing monitoring
URAC: Reported on application, NPDB allowed, 6 month
AAAHC: Disclosed/ evaluated at initial & reappointment

Question 15

Current Competence

Answer 15

CoP: CCTEJ
TJC: Required, comes from PR; 6 General competencies
HFAP: Required at initial & reappointment
DNV: Required at initial & reappointment
AAAHC: Required at initial; comes from PR

Question 16

Attestation Statement

Answer 16

HFAP: Attestation required; not addressed
NCQA: Required at initial & reappointment; 365 (305); “Deeming status” 180 (120)
URAC: Required; electronic acceptable if risk managed
AAAHC: Required

Question 17

CME

Answer 17

TJC: Required @ reappointment
HFAP: Required every 2 years
DNV: CME required