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The Ins and Outs of Medical Staff Credentialing for ASCs

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At the 20th Annual Ambulatory Surgery Centers Conference in Chicago on Oct. 25, Tom Stallings, JD, partner at McGuireWoods discussed why medical staff credentialing is important and how ASCs can take the proper action.

Medicare requires ASCs have the right credentialing of their physicians, one of the basic reasons of why credentialing is important. Another reason? "It could cost you a lot of money if you don't do it right," Mr. Stallings said. There are a few core fundamental areas every ASC should know about when credentialing their physicians and constructing medical bylaws.

Immunity within physician credentialing means if an ASC or healthcare facility is sued, it has protection under the law from paying money. ASCs can receive immunity by looking at both federal and state laws, something Mr. Stallings said is absolutely essential during this process. "It's not enough to know federal law," he said. "You have to know the law in your state, too."

Federal law can grant healthcare organizations immunity in credentialing cases if they follow certain procedural steps, such as acting with due process and fairness in the interest of patient care. These steps generally fall under the Health Care Quality Improvement Act, so ASCs should make certain their medical staff bylaws follow the HCQIA to the letter.

Privilege means an ASC or facility does not have to disclose certain kinds of activities or documents related to credentialing in a case. This specifically applies to peer review of physician credentialing, Mr. Stallings said. Under federal law and the HCQIA, there is no privilege, so ASCs will have to look to state laws to see if there are any privilege or confidentiality provisions.

Reporting obligations
Healthcare facilities are required to report several components of a physician's background and practice to officials, and ASCs must conduct due diligence to find out what they need to report, and to whom, for credentialing purposes, Mr. Stallings said.

Practical advice
Mr. Stallings ended the session by emphasizing ASCs to be active. They should periodically review and revise bylaws, and those bylaws should not merely be copied from the local hospital. Finally, during the credentialing process, it's paramount to monitor both federal and state law, he said.

More Articles on the 20th Annual ASC Conference:

Lessons on Performing High-Acuity Spine Cases in the ASC

Rick Pitino: Act Like You’re On a One-Day Contract

How to Evaluate the Efficiency and Quality of an ASC’s Anesthesia Services

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