Understanding Credentialing and Enrollment Processes: Healthcare Organizations vs. Health Plans


As someone who manages or oversees provider credentialing and payer enrollment for your hospital or healthcare organization, you understand the value of maintaining efficient processes across departments to save time, reduce costs and ensure providers are granted privileges as quickly as possible. Health plans (also known as managed care organizations) strive for similar goals. Understanding the payers’ specific accreditation and regulatory requirements can help you and your team of medical services professionals further ensure timely processing of provider applications. This white paper will explore: the processes payers conduct to evaluate and enroll healthcare providers; common challenges in provider enrollment and how to solve them; and tips and techniques to achieve delegated credentialing.

Why Should Physicians Care About Hospital Finances?

Why should the medical staff care about helping management achieve its financial goals? After all, isn’t the role of the medical staff to practice clinical medicine in an evidence-based manner and for management to count the beans and manage the books? Particularly, why should physicians in community practice care at all? Isn’t the object to… [Read More]

Tackling the Challenge of Physician-Hospital Relations: A Step-by-Step Approach

It seems that conflict is the fastest-growing product line in contemporary healthcare. Medical staff leaders, of necessity, must become comfortable with navigating these potentially treacherous waters. This white paper, Tackling the Challenge of Physician-Hospital Relations: A Step-by-Step Approach, offers practical approaches and strategies designed to help medical staff leaders understand and begin to grapple with… [Read More]

Rethinking ED Call How to balance physician, hospital, and community needs

A recent visit with a hospital and its medical staff struggling with the challenge of physician coverage of unassigned patients for the emergency department (ED) and inpatient consultations was troubling. For that hospital, discussions between some physician groups and the hospital degenerated into anger, threats, and broken trust. The physician demands for ED call compensation easily outstrip… [Read More]

Physician-Hospital Competition and Collaboration

How’s the “weather” for physician-hospital collaboration in your organization? With this white paper, you can answer this and other important questions regarding physician-hospital relationships in your organization. You’ll receive practical advice on how to determine the cultural climate in your organization and implement change. And you’ll learn how to “sail the seven Cs” through core… [Read More]

Peer Review Structures: What’s Out There and Why


CMS and all hospital accreditation organizations require peer review, but do not require any particular way to organize your peer review program. This is a plus for those who want to do effective peer review to meet the needs of their particular medical staff culture and resources. Whatever review structure you choose, make sure it… [Read More]

Managing Disruptive Behavior

One of the most difficult challenges facing medical staff leaders is overseeing professional conduct on the medical staff and confronting disruptive behavior. In addition, there is now a legal, regulatory, and accreditation mandate to eliminate professional conduct that may create a “hostile work environment” and place patients in potential jeopardy. This white paper provides a… [Read More]

How Can Physicians and Hospitals Both Succeed When They Compete and Collaborate?


A senior physician from the largest cardiology group sat down in the hospital CEO’s office. “Bill,” he began, “I’m sorry to tell you this, but our group is going in with the cardiac surgeons on a cardiovascular specialty hospital. We’ll be breaking ground in two months. I just wanted you to hear it from me… [Read More]