Education Flashcards
TJC
Education
On recommendations of the medical staff and approval by the governing body, the hospital establishes criteria that determine a practitioner’s ability to provider patient care, treatment, and services within the scope of the privileges requested including verification of relevant education.
Verification for MDs and DOs can come from:
- The school
- American Medical Association Physician Masterfile (as of 1996) for all US or Puerto Rican medical school education
- Education Commission for Foreign Medical Graduates (ECFMG) for foreign medical school
- The American Osteopathic Association (AOA) Physician Masterfile
- The AAPA profile can be used for: verification of PA education and NCCAP certification
NCQA
Education
CR 3 Factor 3
The organization need only verify the highest level of credentials attained. For example, if a physician is board certified, verification of board certification meets this element because specialty boards verify education and training. Residency is considered the highest level of training, not fellowship
Any of the following can be used to verify education and training:
- the primary source
- the state licensing agency or specialty board, or registry
- sealed transcripts may be accepted if the organization shows evidence that it inspected the contents of the envelope and confirmed that the practitioner completed (graduated from) the appropriate training program
Other acceptable sources for physicians:
- AMA Physician Masterfile
- AOA Official Osteopathic Physician Profile or AOA Physician Master File
- Educational Commission for Foreign Medical Graduates for international medical graduates after 1986
- FCVS for closed residency programs
If the organization uses confirmation from a NCQA approved source (such as state licensing agency or registry) , the organization must verify that the source performs PSV, and, at least annually, the organization must obtain written confirmation from the approved source that it performs primary source verification
NCQA does not require the organization to obtain written confirmation from the licensing board if there is a state statute that requires the licensing board to obtain verification of education and training directly from the institution.
Time Limit: must be verified prior to the credentialing decision
ACHC (HFAP)Acute Care Hospitals
Education
PSV is required and includes AMA Physician Profile, AOA Official Osteopathic Physician Profile, and Educational Commission for Foreign Medical Graduates (ECFMG)
Documentation regarding training and education must be sufficient to support requested privileges
DNV NIAHO for Hospitals
Education
MS.6 SR 4
medical staff bylaws describe the qualifications to be met by a candidate in order for the medical staff to recommend that the governing body appoint the candidate. Those qualifications shall include primary source verification of education on initial appointment.
AMA/AOA profiles are acceptable
ECFMG must be verified if applicable
URAC Health Plan
Education
History of education and professional training must be included on the credentialing application.
If not board certified, the highest level of education or training must be verified from one of the following sources:
- ECFMG
- Professional/medical school
- Residency training program
- state licensing board
An organization can rely on the verification activities of state licensing board. 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.
Verification not required if the practitioner is board certified.
Time Limit: must be verified within 180 days of credentialing decision
AAAHC for Ambulatory Health Care
Education
Education is verified with primary or secondary source on initial appointment
Medicare Hospital COPS and Interp Guidelines
Educationn
482.12(a)(6) and 482.22(c)(4)
The governing body must ensure that the criteria for selection of medical staff are individual character, competence, training, experience, and judgement
