The Application Process (#1) Flashcards
Pre-Application Form
Screens applicants for membership eligibility
Review of Application
- Application= education, training, experience, contact information, dates for PSV, no time gaps
- An application is considered complete when all required information is provided; must be signed & dated
Gaps
Gaps= Medical school- time of application
- All gaps should be explained by the applicant
Practitioner Questions
Any “Yes” requires explanation
TJC on Practitioner Questions
Require statement of no health issues
Investigate:
- Challenges/ relinquishment of licensure
- Termination of medical staff membership
- Limitation, reduction or loss of clinical privileges
- Excessive number of PL actions resulting in final judgment against applicant
HFAP on Practitioner Questions
Application requests following information:
- Disciplinary actions/ investigations by hospitals, boards, Medicare/ Medicaid
- Actions against DEA or CDS
- Actions listed on NPDB
- Information regarding criminal history
DNV on Practitioner Questions
No specific requirements
NCQA on Practitioner Questions
Current & signed attestation required
- Reasons for any inability to perform essential functions of the position
- Illegal drug use
- Loss of license/ felony convictions
- Loss/ limitation of privileges or disciplinary activity
- Current PL coverage
- Correctness & completeness of application
URAC on Practitioner Questions
Application includes:
- History of sanctions
- Loss/ limitation of privileges or disciplinary activity
- Disclosure of any physical, mental or substance abuse problems that could impede practitioner’s ability to provide care
AAAHC on Practitioner Questions
Organization requires information on:
- Complaints or adverse actions by professional society, licensing board
- Licensure disciplinary actions
- Refusal of PL
- Criminal convictions
- Medicare/ Medicaid sanctions
- Current physical/ mental health
- Chemical dependency problems
Red Flags
No reference to quality of care of FV need to be investigated
Red flags should be investigated fully
- Missing dates/ gaps in training/ professional practice
- Discrepancies between information provided & information verified
- Interruption of training
- Hospital privileges listed as “Active” but verified as “Consulting” or “Courtesy”
- Active privileges that become “Courtesy” or “Inactive” without explanation
- Challenges to license/ DEA
- Excessive PL history
- PL canceled for any reason
- Ambiguous peer references
- References/ PSVs that only refer to dates not disciplinary actions