Board Certification (NAMSS Comparison) Flashcards
BOARD CERTIFICATION: A medical staff may not rely solely on board certification when making a decision on privileges. All credentials are examined. MS.6 SR.4a & 5a Any organization required certifications must be primary source verified initially and at reappointment
a. URAC
b. DNV
c. ACHC
DNV
BOARD CERTIFICATION: This is required for initial credentialing only, unless the board certification no record of the verification in the practitioner’s record. If a physician has multiple board certifications, then at a minimum, verify for the specialty under which the practitioner will be listed in the directory
a. URAC
b. AAAHC
c. NCQA
URAC
BOARD CERTIFICATION: The governing body must ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship or membership in a specialty body or society
a. DNV
b. TJC
c. Medicare CoP’s
Medicare CoP’s
BOARD CERTIFICATION: Not specifically required by if the organization requires certification or recertification, verification should be performed. Verification may be obtained directly from the specialty board. ABMS and its certified display agents are considered an equivalent (primary) source. The AOA Physician Database can be used for verification of Osteopathic specialty board certification
a. DNV (NIAHO)
b. TJC (CAMH)
c. AAAHC
TJC
BOARD CERTIFICATION: Verify from primary or secondary source
a. Medicare CoP’s
b. DNV
c. AAAHC
AAAHC
BOARD CERTIFICATION: If a practitioner claims to be board certified, the organization must verify it. Verification of board certification meets the requirement for verification of education and residency training. Verification of board certification is not applicable to nurse practitioners or other health care professionals unless the organization communicates board certification to members
a. NCQA
b. ACHC
c. TJC
NCQA
BOARD CERTIFICATION: The medical staff may not make its recommendation solely based on the presence or absence of board certification, but must also consider the request for clinical privileges, current licensure, training and professional Education, experience, and supporting references of competence. Board certification must be reviewed for each applicant/reapplicant during the review and approval process
a. TJC
b. DNV
c. ACHC
ACHC
BOARD CERTIFICATION: CR 3 Element A Factor 3 and 4. If a practitioner claims to be board certified, the organization must verify it. Verification of board certification meets the requirement for verification of education and residency training. Verification for physicians may be obtained through any of the following: ABMS, its member boards and its approved Display Agents; AOA Official Osteopathic Physician Profile Report; AOA / AMA Physician Master File; Confirmation from the specialty board; Confirmation from the State licensing agency if there is confirmation that this agency conducts primary verification of board status. Must document the expiration date of the board certification in the credentialing file. If it is a “lifetime” certification status with no expiration date, verify that certification is current and document date of verification. Must verify board certification at recredentialing. If the board does not provide the expiration date, the organization must verify that the board certification is current. Note: verification of board certification is not applicable to nurse practitioners or other health care professionals unless the organization communicates board certification to members. Other health care professionals: Verification must come from the appropriate specialty board, State licensing agency or registry if there is documentation that primary source verification of education and training is performed. If not, the organization must also verify the highest level of education and training. The organization may use confirmation from the State licensing agency or registry if it verifies that the source performs PSV, and, at least annually, the organization must obtain written confirmation from the approved source that it performs PSV. Note: the ABMS website provides a public source called “is my Doctor Board Certified” which is not an acceptable form of credentials verification.
a. ACHC (HFAP)
b. TJC (CAMH)
c. NCQA
NCQA
BOARD CERTIFICATION: The medical staff may not make its recommendation solely based on the presence or absence of board certification. A hospital is not prohibited from requiring Board certification, but this cannot be the only criteria used when considering a physician for medical staff membership. A hospital must also consider the request for clinical privileges, current licensure, training and professional: Education, experience, and supporting references of competence. Board certification must be reviewed for each applicant / reapplicant during the review and approval process. Verify with ABMS if physician is certified by a member of board ABMS. If certified by an AOA specialty board, verify with AOA Official Osteopathic Physician Profile. The medical staff may not rely solely on the fact that a Doctor of Medicine / Doctor of Osteopathic Medicine is, or is not, board certified in making a judgment on medical staff membership. This does not mean that the medical staff is prohibited from requiring board certification when considering a Doctor of Medicine / Doctor of Osteopathic Medicine for medical staff membership; only that such certification is not the only factor that the hospital considers. After analysis of all criteria are met except for board certification, the medical staff has the discretion to not recommend that individual for medical staff membership / privilege
a. ACHC (HFAP)
b. Medicare CoP
c. URAC
ACHC
BOARD CERTIFICATION: MS.3 SR.3 A medical staff may not rely solely on board certification when making a decision on privileges. All credentials are examined. MS.6 SR.4a and 5a Any organization required certifications must be primary source verified initially and at reappointment
a. NCQA
b. AAAHC
c. DNV (NIAHO)
DNV (NIAHO)
BOARD CERTIFICATION: Verify board certification, if applicable. This is required for initial credentialing only, unless the board certification no record of verification in the practitioner’s record. If a physician has multiple board certifications, then at a minimum, verify for the specialty under which the practitioner will be listed in the directory. Sources can include the AMA master file, AOA master file, or Special Board of Registry. This accreditation recognizes those sources that the ABMS has designated as primary equivalents as ones that are primary as well. An organization can rely on the verification activities of state licensing boards. If this is done, it should be noted in the credentials file. Confirm that the state board does verify a credential before relying on the board. Time Limit: must be verified within 180 days of the credentialing decision
a. URAC
b. NCQA
c. ACHC (HFAP)
URAC
BOARD CERTIFICATION: §482.12(a)(7) The governing body must ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship or membership in a specialty body or society. In making a judgment on medical staff membership, a hospital may not rely solely on the fact that a MD / DO is, or is not, board certified. This does not mean that a hospital is prohibited from requiring board certification when considering a MD / DO for medical staff membership, but only that such certification must not be the only factor that the hospital considers. In addition to matters of board certification, a hospital must also consider other criteria such as training, character, competence, and judgment. After analysis of all of the criteria, if all criteria are met except for board certification, the hospital has the discretion to decide not select that individual to the medical staff
a. Medicare CoP
b. DNV (NIAHO)
c. ACHC (HFAP)
Medicare CoP
BOARD CERTIFICATION: CR 3 Element Factor A Time Limit: must be verified within 180 days (MCO) / 120 days (CVO) of the credentialing decision
a. ACHC (HFAP)
b. NCQA
c. AAAHC
NCQA
