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Q:

I am new to physician credentialing and want to make sure that the files at our surgicenter are up to date and within the law. How do I find out what I need to have included in our physician credentials files? How do I find a list of all the necessary paperwork to have?
Related Topics
ASC Services
Physician Credentialing
Surgery Center Feasibility
Billing Facility/Office-based Surgery Fees
Surgery Center Certification
ASC-Endoscopy Center Revenue Codes

A:

Your credentialing procedure should be based upon the highest standard whether that be your state statute, Medicare, or an accrediting body such as Joint Commission on the Accreditation of Healthcare Organizations ("JCAHO").

Requirements for physician credentialing and the process required to obtain privileges at an ambulatory surgery center will usually be found in the state statutes governing healthcare facilities.

The requirements for application for privileges vary by state. Generally, however, each physician should complete an application similar to that which is completed for managed care plans and should provide the credentials required by the plans (education, references, license(s) information, board certification, DEA, CV, foreign medical graduate certificates, etc.). This information must be primary source verified which can be performed by an accredited Credentials Verification Organization (CVO). The application should also provide information on the specific privileges requested, including a listing of the procedures the physician will be performing and the type of anesthesia he/she will be personally administering (or supervising the administration of such). The physician should have privileges at a nearby hospital, although that is not always required as long as a transfer agreement is available.

The credentials must be verified and approved by the ASC's governing body before the physician begins performing procedures in the ASC.

Medicare requires that providers be recredentialed periodically. We recommend recredentialing every two (2) years, which should include a review by the governing body of the physician's past performance in the ASC, his/her continued education, the physician's compliance with the ASC's policies and procedures, and his/her ability to perform the procedures in a competent manner (based on Professional Peer Review).

Mary Beth Black (bio..)
Senior Associate


MMA does not provide legal, accounting, or tax advice.  If you need assistance in these areas, we recommend that you consult a qualified professional.  In addition, please note that a client relationship with MMA is not established by the submission of a question to this forum or by the publishing of MMA's response.



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