Credentialing, Privileging, and Medical Staff Governance: Essential Terms and Guidance

Reviewed by Sheri Patterson, CPCS

Covering a wide range of timely functions and terms across today’s diverse practitioner vetting and governance landscape, Credentialing, Privileging, and Medical Staff Governance: Essential Terms and Guidance is an on-the-go, must-have resource packed with information for industry professionals across career stages and healthcare environments.

With reader-friendly coverage of foundational terms like credentialing, privileging, and peer review, new MSPs and medical staff leaders will get up to speed on the tenets of their profession in no time. Meanwhile, experienced MSPs and medical staff leaders can use this tool to refresh themselves on the ins and outs of their roles and as a quick reference while performing their day-to-day duties.

With this book, readers will be able to:

• Provide new MSPs and credentialing coordinators on-the-job spot training
• Save time with a reference guide that addresses, defines, and explains the toughest topics in alphabetical order

Published: October 2018

Page count: 286
Dimensions: 8.5 x 11
ISBN: 978-1-68308-812-7

Table of Contents

 

A

Accountable Care Organization (ACO)

Accreditation Association for Ambulatory Health Care (AAAHC)

Accreditation Council of Graduate Medical Education (ACGME)

Accrediting Entities 

Acquisitions and Mergers

Active Staff

Advanced Alternative Payment Model (APM)

Advanced Practice Professionals (APP)

Affiliate Staff

Agendas

Aging Practitioners 

Ambulatory Surgery Center (ASC)

American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF)

American Board of Medical Specialties (ABMS)

American Board of Physician Specialties (ABPS)

American College of Healthcare Executives (ACHE)

American College of Healthcare Executives Fellow (FACHE)

American Osteopathic Association (AOA)

Appeal

Application Process

Applications

Approval Process

Associate Staff

 

B

Board Certification

Bylaws

 

C

Center for Improvement in Healthcare Quality (CIHQ)

Centers for Medicare & Medicaid Services (CMS)

Certified Professional in Healthcare Quality (CPHQ)

Certified Professional Medical Services Management (CPMSM)

Certified Provider Credentialing Specialist (CPCS)

Collegial Intervention

Competency

Competency Assessment

Computerized Physician Order Entry (CPOE)

Consent Agendas

Consolidated Omnibus Budget Reconciliation Act (COBRA)

Consulting Staff

Continuing Medical Education (CME)

Core Privileges

Council for Affordable Quality Healthcare (CAQH)

Courtesy Staff

Credentialing 

Credentials Verification Organization (CVO)

Critical Access Hospital (CAH)

 

D

Data

Data Bank Reporting

Data Security

Delegated Credentialing

Department Chairs

Department Meetings

Departments

Deposition

Disaster Privileges

Disruptive Behavior

DNV-GL Healthcare USA (DNV)

Doctor of Dental Surgery (DDS)

Doctor of Osteopathy (DO) 

Doctor of Podiatric Medicine (DPM)

Drug Enforcement Agency (DEA)

 

E

Education Commission for Foreign Medical Graduates (ECFMG)

Electronic Health Record (EHR)

Emergency Medical Treatment and Active Labor Act (EMTALA)

Emergency Privileges

Expirables

 

F

Fair Hearing

Federally Qualified Health Center (FQHC)

Federation Credentials Verification Service (FCVS)

Federation of State Medical Boards (FSMB)

Fellowship

File Audits

Focused Professional Practice Evaluation (FPPE)

Foreign Medical Education Verification

Freestanding Facility

G

General Services Administration (GSA)

Governance of the Medical Staff

H

Healthcare Facilities Accreditation Program (HFAP)

Healthcare Fraud and Abuse

Healthcare Quality Improvement Act (HCQIA)

High Reliability Organization (HRO)

Holistic Medicine

Hospital Affiliation

Hospital Systems

 

I

Impaired Physician

Inappropriate Behavior

Initial Applications

Initial Appointment

Interim Staffing

Investigation

 

J

The Joint Commission

 

L

Leave of Absence (LOA)

Letter of Intent

Licensure

Locum Tenens

Low-Volume Providers

 

M

Malfeasance

Malpractice

Managed Care Organization (MCO)

Medical Executive Committee (MEC)

Medical School Education

Medical Staff Categories

Medical Staff Committees

Medical Staff Processes

Medical Staff Structure

Medicare Access and CHIP Reauthorization Act (MACRA)

Medicare Revalidations

Meetings and Minutes

Member Staff

Mergers and Acquisitions

Merit-based Incentive Payment System (MIPS)

Microhospital

 

N

National Association for Healthcare Quality (NAHQ)

National Association Medical Staff Services (NAMSS)

National Committee for Quality Assurance (NCQA)

National Practitioner Data Bank (NPDB)

National Provider Identifier (NPI)

Negligent Credentialing

New Technology Privileges

No-Volume Providers

 

O

Office of Inspector General (OIG)

Officers of the Medical Staff

Onboarding

Ongoing Professional Practice Evaluation (OPPE)

Orientation

 

P

Patient-Centered Care

Patient Safety Organization (PSO)

Peer Evaluations

Peer Review

Physician Burnout

Physician Champion

Physician Employment

Physician Group Practice

Physician Health and Behavior

Preapplication

Primary Source Equivalents

Primary Source Verification

Privileges

Privileging

Provider Enrollment

Provider Enrollment Specialist Certificate (PESC)

 

Q

Qualifications for Appointment

Quality Payment Program (QPP)

Query

 

R

Reappointment

Reappointment Cycle

Red Flags

Regulatory Requirements

Reinstatement

Residency and Fellowship

 

S

Stark Law

State Licensing Boards

Submission of Application

Subpoena

Supplemental Privileges

Surveys

Suspensions

 

T

Telemedicine

Temporary Privileges

Time Gaps

Tracers

Triggers

 

U

Unified, Integrated Medical Staff

URAC

Urgent Care Center

Utilization Review Committee 

 

V

Verification

 

W

With/Without Prejudice

 

Z

Zero Data

About the Reviewer

Sheri Patterson, CPCS, is the owner of Credentials Management, which provides off-site credentialing services for healthcare organizations, locum tenens companies, and practitioners. Additional services offered by Credentials Management include application backlog relief; expirables and database management; committee documentation, bylaws, policy and procedure review and editing; and assistance for practitioners with application completion for facility credentialing and licensure applications. 

Patterson brings over 30 years of varied experience to the table. Her healthcare journey includes experience as a hospital laboratory assistant, cardiac stress technician, and administrative secretary at a county teaching hospital. It was at the teaching hospital that she gained her experience in medical staff committee management and documentation and was introduced to the world of credentialing. She credits the physicians and administrative staff at San Joaquin General Hospital, in Stockton, California, with providing her with a solid base of education and experience in medical staff affairs.

Patterson has experience as a one-person office, team member, and interim staffer in both director and staff positions, all of which have provided her with a unique understanding that different roads can be taken to reach the same goal. Furthermore, she has come to realize that one model, template, or policy does not work for everyone, and it is crucial that all MSPs understand that; doing so allows them to work within a system to foster necessary compliance and change.

Patterson firmly believes that the most important skill one can develop is the skill of listening. Education is her passion. The most rewarding aspects of her career are the opportunities to assist practitioners with navigating the credentialing world and to teach the ropes to those interested in a career in credentialing.

Patterson was born and raised in Stockton, California, has one son, a daughter-in-law, and a granddaughter. She and her husband, Randy, a musician, live in Yachats, Oregon and regularly photograph the beautiful Oregon coast. In her free time, Patterson enjoys sewing, canning and food dehydration, and providing handbags, tuna, and beef jerky to family and friends.