Credentialing & Privileging An Overview for Applicants

1. Credentialing & PrivilegingAn Overview for Applicants Cheryl Schilke, RN, CPMSM Director, Credentialing Services Synernet CVO And Debbie A Hall, CPCS Medical Staff Coordinator Maine Medical Center

2. What is credentialing? • Collecting information about education, training, experience, licensure, criminal actions, ability to get along with others and clinical competence (if privileges requested). • To the extent possible, this information must be verified directly with the certifying organization or peers (Primary Source Verification or PSV)

3. Why is it necessary? • To protect the patientRecommended reading: “Blind Eye: How The Medical Establishment Let A Doctor Get Away With Murder” • To protect the hospital- Maine State Regulations for the Licensing of Hospitals- JCAHO and Magnet Hospital Accreditation standards- CMS requirements for participation in Medicare and Medicaid- Risk Management- Hospitals may be liable for negligent credentialing in malpractice cases

4. Why does it take so long? If application incomplete, illegible or contact information not provided, may delay start of PSV PSV may take up to 45 days Chief may require an interview, may contact peers directly by phone before completing a written evaluation – may take up to 30 days Credentials Committees generally meet once a month – may be 30 days until next meeting Executive Committees generally meet once a month – may be 30 days until next meeting Boards generally meet once a month – may be 30 days until next meeting Total possible 165 days

5. Maine Uniform Applications • Complete once (do not sign and date)– KEEP A COPY • For each submission, update as necessary, photocopy, sign and date. • Form may be downloaded from:http://www.meamss.org/ Select the application appropriate to your credentials

6. Completing the Application • The application must be filled out legibly and completely. Answer every question. If a particular section does not apply to you, mark it N/A. • Provide complete contact information. Fax numbers and/or e-mail addresses are particularly important. • Do not write “see CV” - all information must be on the application. Ensure that the CV and information on application do not conflict. Explain any gaps in professional history, from completion of medical education, of greater than 60 days. • Supply all other names under which you practiced or trained.

7. Some of the information requested is personal, must I answer? • Social security number and date of birth are required because many verifying organizations use them for identification. • Hospitals are required by regulation to ask about your health and how it may affect patient care. The questions on the application do not ask for details, simply whether you require accommodation. You may be required to provide more information later in the process. • You must divulge any sanctions or criminal convictions on initial application. On reappointment, only new actions since your last appointment must be reported. • Home information is kept as confidential as possible. If you have family privacy concerns, please consult the medical staff office.

8. What happens if I forget, omit or falsify information on the application? • Incomplete applications will not be processed. • If it is determined that omission or misrepresentation was intentional, automatic denial of application or termination of membership and/or privileges may result.

9. Where Do You Begin? • Complete Maine Uniform application once. Attach any documents requested in instructions and attach MMC specific documents. • Copy application for your records, THEN sign and mail. This way, you can use the same application for other facilities. • Submit promptly! Remember - we can’t process it if we don’t have it!

10. Then... • You can check in with the Medical Staff Office from time to time. Please note that calling every day does not help. • You can nudge slow references along. • Submit updated DEA, license and insurance certificates as soon as you receive them.

11. The most important thing… • We can’t emphasize this enough • Submit early • Make sure application is complete • Attach all required documents

12. Your responsibility:as applicant • To produce adequate information for a proper evaluation of experience, ethics, background, training, ability to work efficiently and cooperatively with others, and suitability for the clinical privileges and staff category requested • To remove any doubt about these or other basic qualifications for Medical Staff membership • To satisfy all requests for information

13. Your responsibility:as a professional reference • Be candid in your evaluation. Your comments and identity will be confidential to the extent possible. • Return reference forms promptly. Your peers will be grateful and will return the favor.

14. Reappointments

15. Why do I have to re-apply every two years? • Hospitals are required by law to appoint providers for no longer than 24 months. • Failure to reapply means membership and/or privileges simply expire and the provider may no longer provide hospital care after the specified date.

16. What Happens if I Turn In My Reappointment Application Late? • Reappointment applications are subject to the same verification and review process as initial applications. • The same time constraints apply with the added risk that the original appointment will expire before the process is complete. • If the original appointment expires, a new initial application must be completed and if new membership criteria have been established since you joined the staff, you may no longer be eligible.

17. Contact Information • For questions related to application form: Cheryl Schilke, Synernet CVO, 771-3489 ext 1 or cschilke@synernet.net • For questions related to credentialing & privileging: Dyan Albano, MMC Credentialing Specialist 662-2828 or alband@mmc.org • For questions related to MMC Bylaws, Policies or Rules and Regulations, regulatory compliance: Debbie Hall, Medical Staff Coordinator662-2828 or hallda@mmc.org