Tom Jacobs, CEO, and Laura Gifford, HR/Medical Staff Services Consultant at MedHQ, discuss eight ways ambulatory surgery center leaders can strengthen the physician credentialing process.
1. Assign someone to keep track of credentialing. Ambulatory surgery centers must update physician credentials every year or every other year, depending on state requirements. They must also collect credentials for new physicians before allowing them to perform cases at the ASC.
"Licenses expire and you need someone to keep track of the updates and make sure they're filed," says Mr. Jacobs. "We often see it as someone's second, third or fourth responsibility in the ASC. Other times administrators choose to do it as a way to stay connected with their surgeons and keep that relationship going."
2. Plan well in advance to collect credentials before scheduling a new surgeon. It will often take 60 to 90 days for surgery centers to collect all credentialing material required for a surgeon to perform cases at the center; plan accordingly. "You can't just decide you like a surgeon and that he'll start next week," says Ms. Gifford. "You have to go through the process to be cleared."
It's possible for ASCs to grant temporary permission for surgeons to perform cases at the center without all the credentials in place, but perform a background check first to ensure they don't have a high number of adverse events that would put the surgery center at risk.
"Once surgeons are cleared, or has provided a justification for the actions against them, you can allow them to bring cases into the center," says Ms. Gifford.
3. Ask surgeons to make sure forms are fully completed. Oftentimes surgeons' office staff will submit incomplete information to the ASC for their credentials, so more back-and-forth between the administrator and the surgeon's office is necessary before the credentialing process is complete. If you can persuade surgeons, or their secretaries, to check for completion before turning in the forms, you'll streamline the process.
"It's likely to take 60 to 90 days because you are often not getting a full credentialing action when asked," says Ms. Gifford. Other times the delay comes from gathering information from several different places, such as the insurance carrier or state licensing board. Medicare credentials can also hold up the process.
"People forget how long it takes to get all this information, and if you need something from Medicare it will be done on their timeline," says Mr. Jacobs. "At the state level, recently some states have had budget problems that cause delays due to staff reductions."
4. Avoid medicolegal risk by keeping credentials up-to-date. Ambulatory surgery center administrators put the center at risk if they allow surgeons to perform cases there without appropriate and updated credentials. "If something adverse happens to that surgeon's patient at the surgery center, you are exposed to risk," says Mr. Jacobs. "There are also third party claims, especially in Medicare, where you could have legal issues. This is an administrative area that needs to be appropriately done without short cuts."
5. Automated systems can help with updates. It's easy to forget about updating privileges and credentialing at a busy surgery center. However, automated systems can remind administrators and staff members of their credentialing responsibilities. "Practice management and billing systems can be used to help," says Mr. Jacobs. "They have databases built to handle the credentialing information."
ASC administrators should use the features available in their software systems that automatically send an email when licenses are expiring. For a license renewal, the surgeon's office should have those updates ready; contact them and have the updates sent to the ASC as well. Ms. Gifford notifies administrators at least 30 days before an expiration to make sure they have time to gather the renewal.
"You have to be diligent in putting these things into the database and keeping expirations up to date," she says. "There are so many moving parts to that, from the license to the certificate of insurance, board certification and immunizations that organization really is crucial."
6. Know the rules for your state and accrediting body. Most states have similar requirements for credentialing, but make sure you're aware of all the details. This is especially important for surgeons who move in from a different state or type of center. "When surgeons go to a new facility, there might be a wrinkle here or there making the process different from where they were before," says Mr. Jacobs. "Also have a full understanding of what your accrediting body requires so you're prepared for inspection any time."
7. Involve surgeon leaders in developing standards for privileges. Beyond the state and federal requirements, ASCs are required to set standards for the surgeons at their centers. This might mean board certification, fellowship training or other qualifications denoting their experience.
"The place to start with this is your medical director and committee in the ASC to develop the quality expectations, capabilities and competencies you are looking for," says Mr. Jacobs. "Those need to be well-defined with your medical staff from the beginning."
Decide what will be necessary for additional surgeons coming into the center and how they will be assessed. This is especially important for established ASCs looking to add a new service line that didn't previously exist. "There is a process the ASC should go through to decide on what competencies are needed, and everyone should be aware of that," says Mr. Jacobs. "They should be defined before moving forward with the credentialing process."
8. Audit the files on a regular basis. Even though you have alerts and staff members responsible for keeping credentials up-to-date, it's helpful to have an outside person audit the files. Sometimes people who work on the files regularly miss an omission or have other issues they'll need to fix going forward.
"You never know when there might be something overlooked," says Ms. Gifford. "Sometimes staff members take over for another person and didn't realize things weren't complete. It's always nice to get a clear look and perspective on each file to confirm you haven't missed anything. You want to make sure that everything is in place, especially in the event of an announced accreditation review."
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