Malpractice Coverage/Professional Liability Coverage

Question 1

TJC
Malpractice Coverage/Professional Liability Coverage

Answer 1

Not addressed.
However, if the medical staff bylaws/rules/regulations require malpractice coverage, it is expected that the organization have a method to verify such coverage.

Question 2

NCQA Health Plan
Malpractice Coverage/Professional Liability Coverage

Answer 2

• The application form must include specific questions regarding the dates and amount of a practitioner’s current malpractice insurance (even it this is $0) or the organization may obtain a copy of the insurance face sheet from the malpractice carrier.
• Coverage must be current as of the practitioner’s attestation date. - - Future coverage with the effective date and expiration dates is acceptable if the practitioner does not have a current malpractice coverage at the time of application.
• for practitioners with federal tort coverage, the practitioner file can include a copy of the federal tort letter or an attestation from the practitioner of federal tort coverage.
• for reapplication, the application or an addendum to the application must include dates and amount of the current malpractice coverage, or obtain copy of the insurance fact sheet with information

Question 3

ACHC (HFAP) Acute Care Hospitals
Malpractice Coverage/Professional Liability Coverage

Answer 3

Must have evidence of professional liability insurance including current certificates showing amount of insurance; malpractice litigation history from insurance carrier.

Question 4

DNV NIAHO for Hospitals
Malpractice Coverage/Professional Liability Coverage

Answer 4

MS 6 Interpretive Guidelines state that the medical staff criteria for consideration of automatic suspension, summary of suspension and includes when the practitioner has failed to maintain the minimum specified amount of professional liability insurance as required in the medical staff bylaws

Question 5

URAC Health Plan
Malpractice Coverage/Professional Liability Coverage

Answer 5

Proof of liability insurance coverage must be included on the credentialing application.
- a cover sheet or attestation from the insurance company is sufficient to prove attainment of liability coverage.
- the coversheet must include the name of the practitioner, expiration date and the liability covered. If the coversheet does not include the name of the practitioner, a photocopy of those covered under the plan must be submitted to the requester on a sheet that includes the insurer’s letterhead.
- the coversheet must be current and valid when presented to the credentialing committee
- for practitioners who will be starting at a later date, a letter from the insurance company with the future start date and description of the liability coverage is acceptable.
- attestation of malpractice coverage by the practitioner is not acceptable

Question 6

AAAHC for Ambulatory Health Care
Malpractice Coverage/Professional Liability Coverage

Answer 6

• Documentation of professional liability insurance meeting governing body requirements is obtained, if required by the organization
• Verify on an ongoing basis; at a minimum, at expiration, appointment, and re-appointment.
• Verify from primary source
• The application includes information regarding refusal or cancellation of professional liability coverage and is reviewed at initial and re-appointment

Question 7

Medicare Hospital COPS and Interp Guidelines
Malpractice Coverage/Professional Liability Coverage

Answer 7

Not specifically addressed/