Renee Mock, CPMSM, CPCS outlines the journey to paperless credentials files at her hospital in this insightful article. Change is hard, so you need to be up for the challenge. At Hoag Memorial Hospital Presbyterian, we decided to go paperless for two reasons. First, we had already implemented an electronic application and re-application in our provider database, and we didn’t […]
Greeley Senior Consultant Bud Pate shares advice with Becker’s Clinical Leadership on how to avoid adverse findings, and what to do if things go wrong. This article summarizes 30 years of Greeley best practices into a simple guide for those involved with survey preparedness and response. Put simply, hundreds of lessons learned by Greeley’s CMS Termination response and remediation teams form […]
What does a right-sized and optimized medical staff services department look like? And how do you get there?
Sally Pelletier, CPCS, CPMSM, shares the things all high-functioning MSSDs have in common, as well as five key performance indicators (KPIs) leaders can live by and adapt for.
Using proactive external peer review to mitigate the risk of high-dollar lawsuits Medical necessity investigations and lawsuits are a significant threat to healthcare providers, especially those that rely on internal medical staff peer review programs to identify adverse patterns in clinical behavior, according to the new brief Medical Necessity: Checks and Balances Most Hospitals Don’t Have, but Should. The brief […]
Advanced practice nurses and physician assistants are playing increasingly important roles in patient care and organized leadership, stirring up a new set of challenges and opportunities for hospitals and health systems. A growing workforce of advanced practice professionals is countering physician shortages across the U.S., and more of these clinicians are stepping into medical staff leadership positions. The Bureau of […]
Service line co-management, which allows physicians and hospitals to manage a service line as equal partners, is a proven solution for alignment, engagement and even resolving trust issues in hospitals and healthcare sytems. This article featuring Greeley CMO Rick Sheff, MD, discusses the key success factors for service line management done well and how service line co-management can take that […]
In this article, Greeley’s Chief Credentialing Officer Sally Pelletier, CPMSM, CPCS, offers advice and guidance for physician groups, hospitals, and systems about aging policies for practitioners. Aging Baby Boomers may be taking flight out of the general workforce, but in healthcare older practitioners are maintaining strong numbers. In fact, physicians age 65 and older have more than quadrupled since 1975. […]
A well-structured, adaptable medical staff services department (MSSD) can make a real difference in today’s changing healthcare landscape. Mergers and acquisitions continue at a rapid pace, regulatory challenges are increasing, and payment models are evolving, all of which make the credentialing, privileging, and enrollment functions of the MSSD crucial. Increasingly, MSSDs are being tasked with larger objectives, including improving the […]
In this new article published in Becker’s Hospital Review, Amy Niehaus presents three areas CFOs and Revenue Cycle professionals need to explore. By reading “Reclaiming Revenue: A Found-Money Trifecta in Credentialing, Privileging and Enrollment,” you will see that, yes, there is revenue rattling around in the medical staff services department (MSSD). It’s time to reclaim it! Fill out the form […]
The Greeley Company invites you to download a complimentary copy of The Case for Simplification: How Hospitals Can Get Clinicians Back to the Bedside, recently published in Becker’s Hospital Review. Tasked with the need to comply with a vast body of changing regulations and the ever-shifting payer requirements for maximum reimbursement, hospitals have implemented a heavy load of clinical and operational policies in […]
There are several reasons why a commercial payer, such as a managed care organization or health plan, may consider delegating all or part of its credentialing activities to qualified business partners such as IPAs, PHOs, CVOs, medical societies, even other health plans.
The imperative in healthcare today is to rapidly and significantly improve quality and reduce costs. While this goal is easy to articulate, it is incredibly challenging to execute—but the viability of your organization depends on it. We know you’ve squeezed supply costs. You’ve optimized revenue cycle. You’ve “leaned” everything you can. What’s left? The doctors. Achieving the next level of […]
Historically, the medical staff services department (MSSD) has operated behind the scenes in healthcare organizations, with few hospital workers outside the department fully understanding the extent of its responsibilities. However, the MSSD is truly the nucleus of the hospital, as it is responsible for everything from credentialing and privileging practitioners and meeting pertinent accreditation requirements to playing a critical role […]
Hospitals and physicians are grappling with major changes to their industry, as both parties strive to improve quality and outcomes and reduce costs while dealing with changing payment structures. This goal of achieving the triple aim will be impossible to attain without achieving alignment and collaboration between physicians and hospitals, according to Rick Sheff, MD, principal and CMO of The […]
In today’s challenging healthcare environment, certain influencers intensify the need for the routine use of temporary privileges and/or the ongoing use of locum tenens. There is a lot of pressure to quickly get certain practitioners and specialties credentialed and privileged.
The purpose of the credentialing and privileging function and the responsibilities of the medical staff services department within a healthcare delivery enterprise are fairly straightforward. Change is in the wind, however. I am sure many of you are familiar with or have read the change management book, Who Moved My Cheese?, published in 1998 by Dr. Spencer Johnson. It is […]
Data integrity is critical for the credentialing department to appropriately manage the initial application process, timeliness of verifications, recredentialing compliance, and other accreditation requirements. Data also ensures that the customers of the data can trust it for their needs. If the data is not accurate, consistent, valid, and reliable, it will not be trusted. There are many things that can […]
Delegation is a formal process by which an organization gives another entity the authority to perform certain functions on its behalf. In the managed care environment, the volume of practitioners that are required to be credentialed and recredentialed can exceed tens, even hundreds, of thousands based on the size of the plan and its geographic coverage. There are several reasons […]
At leading hospitals all across the country, where quality patient care is of the utmost concern, administrators often struggle with the task of effectively credentialing prospective physicians. There are two main reasons for this: Medical board rules and requirements vary from state to state, making it extremely difficult to hold physician applicants from different parts of the country to a […]
Many compliance-related activities that exist in hospitals today are carried out based on the mythological belief that these things must be done to maintain the strict requirements set forth by regulating bodies such as CMS, The Joint Commission, and others. Hospital businesses are undertaking these efforts and expenses based on the myth instead of the reality. Incredibly, in an era […]
In April 2015, the National Practitioner Data Bank (NPDB) published its first new guidebook in 13 years. It includes a significant expansion of the NPDB’s definition of an investigation with direct impact on reporting requirements for physicians or dentists who resign while under investigation. Across the country, medical staff leaders, medical services professionals, and healthcare attorneys have expressed strong concerns […]
We have all had beliefs we held to be true, only to find out at some point in the future that those beliefs were myths. And most of us have experienced or witnessed the crippling effects that the belief “more is better” can have. Steve Bryant, Senior Vice President and Managing Director of The Greeley Company, understands how regulatory myth, overinterpretation, and complexity manifests itself in hospital policy, […]
As more practitioners and newly-minted medical school graduates seek hospital-based employment, the need for quality credentialing grows. On top of this, as hospitals form more expansive networks and systems, small inefficiencies in individual credentialing processes compound and become increasingly disruptive at the network and system level. The Greeley Company has identified today’s top four common credentialing challenges: Inconsistency and lack of standardization […]
Healthcare’s second curve is coming fast. Hospital and health system leaders know they won’t survive it without improving alignment, collaboration and trust with physicians.
The first curve was all about pay for volume. Physicians had to crank RVUs and hospitals needed heads in beds.
If your hospital has received a Statement of Deficiencies (CMS Form 2567) with Notice of Immediate Jeopardy or Notice of Termination, it has been determined that your hospital has a condition-level deficiency. This means your hospital is not in substantial compliance with one or more of the CMS Conditions of Participation. Condition-level deficiencies are more serious than element-level or standard-level deficiencies, […]