Are you hearing the word “credentialing” being used differently by people these days? There are many functions coming under the umbrella of credentialing but maybe we need to look at the similarities and differences of the functions. This program will review the functions of traditional credentialing and provider enrollment, compare and contrast the tasks and suggest ways that working together may not only enhance the two processes, but could offer some new job opportunities.
Objectives:
1. Distinguish the similarities and differences between credentialing specialists and provider enrollment specialists
2. Analyze the basics of each profession to better understand areas of collaboration and opportunity
3. Theorize why BOTH heads and tails makes for an optimal career development pathway
Presentation of those “other” types of privileges, temporary x2, locum tenens, provisional (NCQA), expedited – when should you use them and what do the standards allow or not mention.
Objectives:
1. Discuss methodologies and standards (TJC, ACHC/HFAP, DNV, CMS, NCQA) for processing non-routine privileging paths
2. Review scenarios for non-routine privileging paths and choosing the best process to follow
3. Identify applicants who require and/or request non-routine credentialing/privileging paths and what you need in place to facilitate best practices
4. Share the language needed in bylaws, policies, etc., distinguishing differences between privileging criteria and membership criteria
Janet Wilson has been involved in the medical staff services, quality, and credentialing industry for the past 40 years. Her healthcare experience extends to hospitals, ambulatory care, quality/peer review, managed care, and the CVO environment.
Janet served for three years on the National Association Medical Staff Services (NAMSS®) Board of Directors and was designated a Fellow by NAMSS® in 2019. She also served on the Board of Directors of the Texas Society of Medical Staff Services and held the office of President during her tenure on the board.
Janet has also provided consulting services for over 26 years in the areas of credentialing/privileging, quality/peer review, governance, CVO development, and medical staff services. She has also worked as an independent educator in the healthcare industry for 22 years and has spoken at numerous state and national conferences. Janet served as a NAMSS®instructor for 10 years and is also on the faculty of
Edge-U-Cate, LLC and teaches CPCS®/CPMSM® certification focused study programs and many other industry related programs.
Janet co-authored the ninth and tenth edition of HCPro’s Verify and Comply: Credentialing, Medical Staff, and Ambulatory Care Standards which is an industry guide for regulatory and accreditation standards. She also provides annual updates to the AMA standards table related to the AMA Physician Profile and Continuous Monitoring Services and is a member of HCPRO and Decision Health’s Credentials Resource Center Editorial Board.