Practitioners Credentialed & Privileged through the Medical Staff

Question 1

The Joint Commission CAMH
Practitioners Credentialed & Privileged through the Medical Staff

Answer 1

all individuals who are permitted by law and the hospital to provide to provider patient care independently in the hospital - whether or not medical staff members (physician or other licensed practitioner) are required to be credentialed and privileged under the Medical Staff standards.
This includes physicians or other licensed practitioners who are hospital employees.
For hospitals that use Joint Commission accreditation for deemed status purposes, in accordance with state law, including scope of practice laws, the medical staff may also include other categories of physicians listed at 482.12(c)(1) as well as non-physician practitioners determined to be eligible for appointment by the governing body.
For hospitals that use Joint Commission accreditation for deemed status purposes: when a multihospital system has a unified and integrated medical staff, the medical staff bylaws include the following requirements:
- a description of the process by which medical staff members at each separately accredited hospital (that is all medial staff members who hold privileges to practice at that specific hospital) are advised of their right to opt out of the unified and integrated medical staff structure after a majority vote by the members to maintain a separate and distinct medical staff for their respective hospital

Question 2

NCQA
Practitioners Credentialed & Privileged through the Medical Staff

Answer 2

Note: NCQA standards address credentialing not privileging.
Practitioners within the scope of credentialing include:
- practitioners licensed, certified or registered by the state to practice independently (without direction or supervision)
- practitioners who have an independent relationship with the organization
- practitioners who provide care under the organization’s medical benefits
This would include the following:
- Individual/group practices
- facilities
- rental networks
- telemedicine
Credentialing policies and procedures include medical practitioners (medical doctors, oral surgeons, chiropractors, osteopaths, podiatrists, nurse practitioners, and behavioral healthcare practitioners (psychiatrists and other physicians, psychologists, social workers, addiction medicine specialists, clinical nurse specialists, psychiatric nurse practitioners and other behavioral health specialists.

Question 3

ACHS Acute Care Hospitals
Practitioners Credentialed & Privileged through the Medical Staff

Answer 3

Standards regarding medical staff composition are a direct quote of CMS 42 CFR 482.22(a) and 482.12(a)(1)
The following additional comments are included: The governing body must ensure that any privileges granted to non-physicians are in accordance with state law, regulations, and scope of practice

Question 4

DNV NIAHO for Hospitals
Practitioners Credentialed & Privileged through the Medical Staff

Answer 4

MS 2 SR 2
The governing body shall determine, in accordance with state law, which categories of practitioners are eligible candidates for appointment to the medical staff.
SR 3 The medical staff shall include doctors of medicine or osteopathy in accordance with state law, including scope of practice laws, the medical staff may also include other types of practitioners included in the definition of a physician in Section 1861(r) of the social security act and categories of non-physicians practitioners determined as eligible for appointment by the governing body.
SR 4 When the hospital utilizes non-physician practitioners who are assigned patient care responsibilities (which may or may not include formal medical staff privileges, but excluding nursing care services), there shall be established policies and procedures, approved by the medical staff, and governing body, for overseeing and evaluating their clinical activities.
SR 5 The medical staff shall examine the credentials of all eligible candidates for medical staff membership/appointment and make recommendations to the governing body on the appointment of these candidates in accordance with state law, and the medical staff bylaws, rules, and regulations

Question 5

URAC
Practitioners Credentialed & Privileged through the Medical Staff

Answer 5

All practitioners listed in the directory and are providing covered healthcare services to consumers are credentialed. Examples include:
- MDs/DOs
- Chiropractors
- Non-physicians including nurse practitioners, physician assistants, nutritionists, etc
- alternative medicine providers - massage therapist, acupuncturists, etc
- mental health providers - psychologists, certified addiction specialists, etc
- acute in-patient facilities such as hospitals
- free-standing surgical centers
This includes individual practitioners providing clinical services in group practice settings and freestanding clinics even if the individual practitioners are not listed in the organizations provider directory or do not contract directly with the network organization
Physicians who are employees of a facility as hospitalist and who are not listed in the provider directory are not included.

Question 6

AAAHC for Ambulatory Health Care
Practitioners Credentialed & Privileged through the Medical Staff

Answer 6

At a minimum physicians and dentists are credentialed and privileged. Board determines which other qualified professionals (AHPs) it wishes to allow on staff