Credentialing and Privileging Flashcards
1
Q
What is TJC’s definition of credentialing?
A
the process of obtaining, verifying and assessing the qualifications of a health care practitioner who seeks to provide patient care services in or for a hospital
2
Q
How does NCQA define credentialing?
A
a process by which an organization reviews and evaluates qualifications of licensed independent practitioners to provide services to its members
3
Q
What are the three main reasons for credentialing
A
- Patient Safety
- Risk Management Concerns
- Accrediting and regulatory agency requirements
3
Q
what are the CoP’s & why are they important?
A
Medicare Conditions of Participations (CoP’s) - conatined in the Code of Federal Regulations, are intended to protent patient health and safety and to ensure quality of care for hospitalized patients
4
Q
What are the three main reasons for credentialing?
A
- Patient Safety
- Risk Management Concerns
- Accrediting and regulatory agency requirements
5
Q
why get accredited?
A
- assists organizations in monitoring and improving quality of care
- can be used to meet Medicare certification requirements
- marketing reasons, publish accreditation status
- may favorably influence liability insurance premiums
- for a hospital, accreditation may be required in order to obtain managed care contracts
- ## employers and unions may require an organization to be accredited as a requirement for providing healthcare coverage to employees
