Each payer has its own timeline for
recredentialing as well as differing requirements for peer review, quality assurance, and prior authorization.
These data are considered in the nurse employee evaluation process as well as the physician
recredentialing process.
Data must be analyzed at least every 6 months and made available to CMS "upon request" and as part of the CMS process of
recredentialing facilities.
The court held, inter alia, that the trial judge correctly concluded that the plaintiff was required to present expert testimony as to the standard of care in credentialing and
recredentialing as well as testimony that the hospital, in fact, breached the applicable standard of care.
First, there's that issue of "
recredentialing." The NBRC is an accredited board of the National Commission for Certifying Agencies (NCCA), an arm of an umbrella organization originally set up by the federal government to set standards for all certifying boards.
In addition to all of the records listed by CLIA and CAP, JCAHO may want to see professional staff meeting Minutes; records of professional and technical staff training and continuing education; records of safety training; and data used to make recommendations about
recredentialing of professional staff members.
Clinicians also need to know the basis for credentialing and
recredentialing decisions.
The court held, inter alia, that the plaintiffs claims against the hospital for negligent credentialing and
recredentialing were not helthcare liability claims because the hospital's alleged acts or omissions that formed the factual basis for the claims could not be considered medical care or healthcare as defined in the Act.
Godat's actions, (2) the hospital was immune from liability under the Texas Medical Practice Act, (3) the hospital met the applicable standard of care when
recredentialing Dr.
Internal documents may also describe the company's system for tracking authorizations and denials and how this information is used for utilization management, quality management, physician profiling, credentialing and
recredentialing, and financial management.
Through credentialing, the MCO accesses and monitors the qualifications of health care providers by evaluating the provider's education, training, and experience, as well as judgment and competence as demonstrated through empirical data.[29] The "
recredentialing" process addresses providers who fail to accomplish the MCO's required cost-effective quality care, as indicated by member complaints and improper utilization methods, among other things.[30]
For example, one plan had purchased software for credentialing and
recredentialing, but was not yet in compliance with much of this standard.
