The Greeley Company’s Guiding Principles for Credentialing in Today’s Integrated Healthcare Environment
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The Greeley Company Guiding Principles for Credentialing and Privileging
1.
Credentialing exists to protect patients, healthcare organizations, and healthcare practitioners
2.
Some credentialing decisions are black and white and some are gray a.
Credentialing’s Other ROI: The Revenue Cycle Trifecta
Credentialing entia
Balancing physician success, hospital success, and good patient care
Revenue veenu y Cycle
No one works without authorization Job description
Delegation on
Contract defining scope of services rendered
Provider P E r En Enrollment
Delineated clinical privileges Any combination of the above 4.
Beware the two types of credentialing errors: information errors and decision errors
5.
Credentialing traditionally consists of four steps. Today’s integrated environment requires a fifth step.
6.
Follow the 5Ps
7.
Excellent credentialing and privileging requires clear criteria consistently applied and evaluated
8.
Do not deny unnecessarily!
9.
Getting value from references requires thoughtful design, careful reading, and use of the telephone
10. Place the burden on the applicant 11.
Treat like practitioners in a like manner
12. Before granting or renewing privileges, solve the Greeley Competency Equation
5
Credentialing in today’s integrated environment requires five steps
5Ps The Greeley Physician Engagement Cycle
The 5Ps Our Policy is to follow our Policy. In the absence of a Policy, our Policy is to create a Policy.
Recruitment Reappointment Verification
OPPE
Peer Review
Credential
Privilege
Step 1: Establish policies and procedures (e.g., credentials committee, MEC, medical staff, management, and governing board)
FPPE Enrollment
Step 2: Integrate the collection, verification, analysis and summary of credentialing information with recruitment and provider enrollment (e.g., management and medical staff leaders)
Onboarding
Revenue Cycle
Step 3: Evaluate and recommend (as per organizational structure, e.g. department chair, credentials committee, MEC, and management) Step 4: Grant, deny, or modify (governing board or designated agent); hire/contract (management)
•
Provider enrollment (achieving participation status and provider ID)
•
Practitioner orientation
•
Initial monitoring
14. Do not confuse membership with privileges
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Mentorship
5 Cherry Hill Drive, Suite 200 Danvers, MA 01923 Telephone: 888-749-3054 Web: www.greeley.com
Physician Alignment and Clinical Integration
The Greeley Competency Equation
Step 5: Complete the onboarding process (e.g., management and medical staff leaders)
13. To match competency with privileges, use the Greeley Competency Triangle
15. Base credentialing and privileging decisions on the affirmation of current competence and conduct, not the absence of negative information
Information Error: Information existed that could have been known but wasn’t, and the information would have impacted a credentialing decision Decision Error: The necessary information was known, but leaders failed to make the wise decision
b. Balancing “manage loose” and “manage tight” 3.
Credentialing Errors to Avoid
Have you done it recently
+ When you did it, did you do it well? = Competency Privile Privilege Delineation Deline
The Greeley Competency Triangle Eligibility Criteria
Peer Review Results