Credentialing, Privileging, Clinical Competence, and Peer ...
Credentialing, Privileging, Clinical Competence, and Peer Review
September 10, 2015
Credentialing, Privileging, Clinical Competence, and Peer Review
Jennifer Comerford, MJ, OTR/L, CHC
9/4/2015
?2015 EC RI I N S TI TU TE
Learning Objectives
1. Recognize the importance of thorough credentialing and privileging practices
2. Recognize the relationship between clinical competence and quality of care
3. Identify how provider quality measures can be used for assessment of clinical competence
4. Develop strategies to manage the peer review process 5. Identify how achievement of quality goals can mitigate
risk
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Credentialing, Privileging, Clinical Competence, and Peer Review
9/4/2015
Credentialing and Privileging
Learning Objective #1: Recognize the importance of thorough credentialing and privileging practices
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?2015 EC RI I N S TI TU TE
What is Credentialing?
The process of verifying that a licensed/certified healthcare practitioner is currently qualified to practice in his/her profession
The "paper" piece Training Education Certifications Licensure DEA number Health record Immunizations National Practitioner Data Bank (NPDB)
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Credentialing, Privileging, Clinical Competence, and Peer Review
What is Privileging?
Assessment of providers' education, training, and developed skills that contribute to the provision of patient care within the health center's scope of practice
9/4/2015
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What is Clinical Competence?
The capability to perform acceptably those duties directly related to patient care
Includes: Professional behavior Clinical skills Medical knowledge
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Credentialing, Privileging, Clinical Competence, and Peer Review
What is Peer Review?
Process that evaluates the quality and performance of healthcare ordered or provided by licensed independent practitioners
Goal is to prevent harm to patients and improve the quality of healthcare
Specific, formal, targeted Protected by state laws
9/4/2015
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Why Credential and Privilege?
Promote quality of care Support patient safety Reduce risk of potential liability Satisfy reimbursement requirements Satisfy FTCA requirements (PIN 2002-22; FTCA Policy
Manual)
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Credentialing, Privileging, Clinical Competence, and Peer Review
9/4/2015
What is the Difference Between Credentialing and Privileging?
Credentialing
Step 1 Vetting the provider "Paperwork" (e.g.,
licensing, education)
Privileging
Step 2
Authorizing the provider's scope of practice
Within health center scope of services
"Skills and abilities" (e.g., competence, specialized training)
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Primary vs. Secondary Source Verification
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