6 Tips to Meet Credentialing Standards from AAAHC

In the Accreditation Association for Ambulatory Health Care’s March 2014 Connection newsletter, the organization notes a finding from its AENEID report: that credentialing was the most commonly partially compliant or non-compliant survey item.

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The AAAHC provides six tips to better meet credentialing standards for accreditation and reaccreditation based on specific deficiencies the organization sees:

1. An organization may not rely on another organization to credential its medical and dental staff.

2. An organization can only privilege its physicians and dentists for those procedures that the facility is equipped for, capable of performing and that are approved by the governing body.

3. Documentation of the initial process and the reappointment application must include a specific time period for which the privileges are granted to the physician or dentist.

4. Specific privileges such as anesthesia, fluoroscopy, laser and supervision, to name a few, should be documented.

5. Peer review is required for the reappointment process and requires two physicians or dentists to review.

6. The peer review process should not be limited to the clinical record only, but also include other items such as infection rates, patient satisfaction survey results and compliance to medical staff rules and regulations.

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