Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 10th Edition

Get the latest version of the medical staff services industry’s most trusted compliance manual.

Now includes URAC standards!

For over 20 years, Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 10th Edition, has been of HCPro’s most popular credentialing and accreditation resources. Credentialing and medical staff standards and regulations are covered in one easy-to-navigate side-by-side crosswalk, giving medical staff services and credentialing professionals one book that answers all their accreditation questions.

Updated for 2022, this guide includes ambulatory care, acute care, and managed care standards for the most popular regulators and accreditors: CMS, The Joint Commission, NCQA, DNV, HFAP, AAAHC, and URAC. This book allows you to compare what each accreditor states about initial appointment, reappointment, and other medical staff functions, and provides tips and best practices to help you meet the most challenging standards. Use this resource to study for the NAMSS certification exam and to keep up to date with regulators’ and accreditors’ credentialing and medical staff standards.

This book will help you: 

• Determine which verifications are necessary to obtain in the credentialing process
• Understand the differences between the appointment, reappointment, and ongoing assessment stages of the credentialing process
• Implement best practices in your medical staff services department that ensure compliance with your accreditor’s standards
• Identify the appropriate areas in medical staff governance documentation to include specific items required by accreditation standards and regulations
• Adopt expert processes for complying with telemedicine and ambulatory accreditation standards

Click here to access chapter previews.

Published: November 2022

Dimensions: 8.5” X 11” spiral bound
ISBN: 978-1-64535-198-6

Table of Contents

Section 1: Acute Care & Managed Care: Credentialing Standards

• Chapter 1: Initial Appointment, Clinical Privileges, and Credentialing
• Chapter 2: Reappointment, Renewal/Reappraisal of Clinical Privileges, and Recredentialing
• Chapter 3: Other Credentialing Aspects

Section 2: Medical Staff Acute Care Hospital Standards Not Related to Credentialing

• Chapter 4: Medical Staff Structure, Bylaws, and Involvement in Organizational Leadership Functions and Required Committees
• Chapter 5: Oversight of Patient Care, Treatment, and Services and Performance Improvement
• Chapter 6: Medical Staff Involvement in Patient-Focused Areas and Patient Therapeutic Services

Section 3: Ambulatory Care: Credentialing Standards

• Chapter 7: Initial Appointment, Reappointment, Clinical Privileges, Credentialing, and Recredentialing
• Chapter 8: Other Credentialing Aspects

About the Authors

Stephanie Russell, BS, CPMSM, CPCS, has over 35 years’ experience as a healthcare executive in medical staff services and credentialing.  She has worked in both large university settings and community hospitals, managing both single and multiple hospital medical staffs.

Russell’s experience includes oversight of medical education, graduate medical education, bylaws, regulatory compliance and accreditation, health system credentialing for both hospitals and health plans, credentialing service contracts for outside entities, delegation agreements, audits, and CVOs.

Russell was a National Association Medical Staff Services (NAMSS) instructor for more than 10 years and has made many presentations at state and national educational conferences on topics related to credentialing, privileging, professional development, and NCQA and Joint Commission regulatory compliance. She was instrumental in creating the NAMSS Leadership course and taught it the first two years it was offered. She is a past member of the NAMSS Board of Directors and the Illinois Association Board of Directors. She has also been a collaborator and coach with Team Med Global since its inception, expanding her teachings to include practice management, managed care, and quality for medical staffs and hospitals. She coauthored the previous three editions of Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards.

Janet Wilson, BS, FMSP, CPMSM, CPCS, has been involved in the medical staff services, quality, and credentialing industry for the past 36 years. Her healthcare experience extends to hospitals, quality, managed care, and the CVO environment. Wilson served for three years on the 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.

Wilson is the president of JLWIlson MedStaff Consulting. She has been an independent consultant for more than 15 years and focuses on credentialing, privileging, quality, CVO development, and medical staff services. She has also worked as an independent educator in the healthcare industry for 14 years and has spoken at numerous state and national conferences. Wilson coauthored the previous two editions of Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards and has been a NAMSS instructor for the past 10 years. She is also on the Faculty of Edge-U-Cate and teaches certification focused study programs and other industry-related programs.