Healthcare Credentialing | symplr Blog

Five Tips for Mitigating the Risk of Negligence in Provider Credentialing and Privileging

Written by Kathy Matzka | Jul 14, 2016 2:00:00 PM

As you know, provider credentialing and privileging is crucial to your compliance program – and to protecting the safety and welfare of your patients. To ensure quality patient care and help shield your organization from negligent credentialing lawsuits, start by making sure your teams have access to a reliable, up-to-date provider privileging database. Then, follow these steps to further reduce your healthcare organization’s risk of negligence in credentialing and privileging:

1. Train MSPs and medical staff leaders.

Encourage your MSPs to attend educational programs that enhance their skills in credentialing and privileging. In addition to on-the-job training, your staff may find educational resources and training available through the National Association of Medical Staff Services (NAMSS) and state associations helpful. Meet with your department chairs, especially the newly appointed ones, to explain your credentialing and privileging processes in detail. Share your expectations for reviewing credentialing files and carefully outline each team member’s responsibilities. Encourage them to ask questions, note concerns and be meticulous in their reviews, reminding them they may be liable if they overlook any information.

2. Involve MSPs and medical staff leaders in all phases of credentialing and privileging.

MSPs and medical staff leaders both have a role in ensuring your organization appoints competent physicians. When the two parties work together, everyone will better understand their own role and responsibility in the process. For example, it’s essential that your medical staff leaders read all credentialing information, including verification letters and any other materials necessary to form a reasonable conclusion regarding a physician’s competency. Emphasize to medical staff leaders how important it is to thoroughly review – but not rely exclusively on – the work of MSPs when granting privileges to physicians. Make sure they know that they can request additional information if they don’t feel they have enough data to make a reasoned decision. It’s also a good idea for MSPs to jointly review credentialing and privileging files with department chairs, credentialing committee members and medical executive committee members. When it comes to a negligent credentialing claim, everyone involved may be required to provide a deposition.

3. Follow all policies, procedures, and bylaws.

As you know, accreditation standards can change over time, so your organization’s bylaws may require updates to mirror any new requirements. If you notice a difference between current practices and your organization’s bylaws, it is best to defer to the strictest requirements to ensure compliance until you can resolve the discrepancy. Your organization may also have requirements that go above and beyond professional accreditation standards. Make sure these requirements are part of your provider credentialing and privileging process as well. For example, if your healthcare facility requires all physicians to be board certified or obtain board certification within a certain amount of time, hold all physicians to that standard. Do not make exceptions without proper documentation. Most importantly, current practices should be reflected in your bylaws as documentation of the process.

4. Document all concerns raised by your MSPs or review board.

Another potential area of negligence is the failure to address any concerns identified during the provider credentialing or re-credentialing process. The documents in your credentialing files should make note of these concerns, describing in detail how your organization responded. For example, if a physician was named in a number of malpractice lawsuits that have not been settled and your medical staff leaders proceed with granting privileges to the physician, document the review board’s ultimate decision. Explain how and why the final determination was made and keep record of it for reference if needed.

5. Stay current with industry developments and technology advancements.

The ability to cross-reference your files with a continuously updated provider privileging database is the foundation for reducing the risk of negligence. Provider privileging software libraries allow MSPs, medical staff leaders, and other staff to review privilege requirements and current privileges in detail, ensuring your staff has real-time access to privileging information.

By empowering your teams with access to the most current information and a thorough, collaborative review process, you can reduce the risk of errors and oversight. To learn more about how to improve your organization’s credentialing and privileging process, listen to the symplr webcast, Understanding Negligence in Credentialing. To view and share the details of case law examples that set precedent for holding healthcare organizations liable for negligence in credentialing, see Negligent Credentialing Lawsuits: Case Law Examples.

Want to reduce the risk of negligence in provider privileging? With Provider Privileging from symplr, you get the most comprehensive and only online customizable privileging database kept current by a team of expert researchers. With symplr’s user-friendly, continuously updated database, MSPs can easily review privilege information and update re-appointment requests at the click of a button. To learn more about Provider Privileging from symplr, schedule a demo now.