Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 9th Edition

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Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 9th Edition

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Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 9th Edition

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

For 20 years, Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards, 9th 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 2021, 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, and AAAHC. 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 2021

Page count: 316
Dimensions: 8.5” X 11” perfect bound
ISBN: 978-1-64535-159-7

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, is the southern region director of medical staff services and credentialing at UCHealth in Colorado Springs, Colorado. After a lifelong career in Northern Illinois, she moved to Colorado and now oversees four facilities, with three medical staffs, include a critical access hospital.

She has been an executive medical staff services professional for over 30 years, overseeing 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, as well as delegation agreements and audits.

Russell is a National Association Medical Staff Services (NAMSS) instructor and has made many presentations at state and national educational conferences on topics related to credentialing, privileging, professional development, and regulatory compliance for both NCQA and The Joint Commission.  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. Russell was instrumental in creating the NAMSS Leadership course, and taught it the first two years it was offered. She co-authored the seventh and eighth editions of Verify and Comply, Credentialing, Medical Staff and Ambulatory Care Standards. 

Janet Wilson, BS, FMSP, CPMSM, CPCS, began her career in healthcare in 1986 and over the past 35 years she has managed and directed medical staff services in independent and multihospital systems, ambulatory care centers, physician groups, health plans (delegated credentialing), and independent and system CVOs.

Wilson has extensive experience in credentialing and privileging, bylaws development and revisions to meet regulatory/accreditation standards, delineation of privileges development and maintenance, medical staff leadership and new practitioner orientation and education, performance improvement and peer review, and development and standardization of policies and procedures/forms/documents across multiple healthcare settings. She has been involved in mergers and acquisitions, unification of medical staffs, impaired/disruptive physician management, and hearings and appeals. Wilson also has extensive experience in delegated credentialing and CVO development and management for independent hospitals and multihospital systems.

Wilson served for three years on the board of directors of NAMSS. She also served on the board of directors of the Texas Society of Medical Staff Services and served as its president during her six-year tenure on the board.

Wilson has served as an independent educator and consultant for 14 years and has spoken at numerous state and national conferences. In addition, she has served as faculty for Edge-U-Cate, LLC and taught certification focused study programs and other industry related programs. Wilson has also served as a NAMSS instructor for the past 10 years and has participated in the development of education programs related to credentialing and privileging, managed care, leadership, and professional development. She co-authored the eighth edition of Verify and Comply: Credentialing, Medical Staff and Ambulatory Care Standards.