html5-img
1 / 10

Hospital and Insurance Credentialing

Hospital and Insurance Credentialing. Pat Borman, MD Practice Management Didactics. WHO CREDENTIALS. HOSPITALS HEALTH INSURANCE COMPANIES HEALTH DELIVERY SYSTEMS HMO’s. WHY CREDENTIALING.

Lucy
Télécharger la présentation

Hospital and Insurance Credentialing

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Hospital and Insurance Credentialing Pat Borman, MD Practice Management Didactics

  2. WHO CREDENTIALS • HOSPITALS • HEALTH INSURANCE COMPANIES • HEALTH DELIVERY SYSTEMS HMO’s

  3. WHY CREDENTIALING • Hospitals and Health Insurance Companies and Health Care Delivery Systems have a legal and ethical responsibility to the public and insureds to insure that physicians are adequately trained to practice quality medicine with reasonable skill and safety.

  4. Hospital Credentialing:The Process • Request application and complete it • If anything is missing this causes delays • Be neat, accurate, complete, professional • Passport size photos • Include the check for required amount • Currently at Swedish $350 complete in 3-6 months or $850 complete in 30-45 days

  5. Hospital:The Credentialing Process • Completing the Application • Request ALL the privileges you qualify for and supply documentation • Never request privileges you do not qualify for • Letters of Recommendation: Program Director and others • Releases Criminal Background Check and National Practitioner Data Bank

  6. VERIFICATION • Each entry in your completed application is verified at the source • Now your application is complete and confirmed as true and accurate • File is forwarded into committees for recommendation.

  7. RECOMMENDATIONS • Chief of Family Practice reviews your file and makes a recommendation for appointment to the Credentials Committee • In some hospitals each department you work in must sign off: OB/GYN, PEDS, SURGERY, MED before the Credentials Committee reviews your file

  8. RECOMMENDATIONS • The Credentials Committee reviews everything again and passes a recommendation to the Executive Committee. • The Executive Committee will make a recommendation to the Board of Directors of the Hospital

  9. Final Determinations • The Board of Directors of the Hospital has FINAL AUTHORITY in privileging: • Grant • Deny • Modify • Revoke

  10. Insurance and HMO Credentialing • Application is similar • Verification Process is the same • Tend to be fewer layers of Committees to seek approval

More Related