Credentialing Documentation Checklist to Avoid Negligence

Provider Credentialing with Good Documentation and Solid Bylaws Protects Against Litigation and Settlements.

This blog outlines tips to avoid litigation around provider credentialing, privilege granting, and health care compliance. There is a great discrepancy between the facts of an event at the time of its occurrence and the memory of it weeks, months, or years later. Often between the time of credentialing and the adverse event under review staff, leadership, and board members have changed.

The provider credentialing checklist by Hugh Greeley gives solid checks and balances from a provider credentialing documentation standpoint.

However, good documentation is only valuable when it is recording actions that follow bylaws based on best practice credentialing that exceed the minimum compliance requirements, and first and foremost, put the patient’s safety and quality of care first.

By Hugh Greeley, author of Hugh’s Credentialing Digest

Negligent credentialing litigation is no laughing matter. Defense costs add up quickly and settlements to avoid a costly trial are common. Unfortunately, many hospital executives and the majority of health care leaders remain relatively uninformed about this type of litigation. While it is likely that they have heard of a few of the cases resulting in a legal victory for the plaintiff, they rarely take the time to focus on the internal workings of the organization’s credentialing program in order to make changes that might mitigate defense costs and reduce the need for settlements.

QUALITY OF DOCUMENTATION IS KEY

Most negligent credentialing cases seem to hinge on the substandard documentation and not on poorly performed background checking, review by leaders, or privileges granted.

HERE ARE A FEW TIPS TO CONSIDER WHEN PERFORMING A CREDENTIALING DOCUMENTATION AUDIT:

1. Do bylaws and related documents clearly describe your individual process and not simply mimic requirements?
2. Are all applications, privilege request forms, and related documents clearly dated?
3. Is there evidence that all forms are completely filled out? If not, is there evidence that omissions were noted and either accepted or otherwise handled?
4. Is documentation regarding an applicant’s or reapplicant’s history (education, training, experience, etc.) complete, logically organized, and with all verifications dated?
5. Is there a clear linkage between privileges granted and the specific basis for such grants?
6. Are all reviews by chairs, committees, and the board clearly documented, signed, and dated?
7. Are all questions concerning the applicant or reapplicant clearly identified and resolved?
8. Of perhaps greatest importance, is there evidence and documentation that you have identified credentials flags, such as malpractice cases, frequent relocations, certification or licensure issues, less than “excellent” recommendations, etc., and that these flags have been addressed by relevant leaders during the review process?

Four years after a reappointment, it is tough to convince an attorney that your department chair noted the five prior malpractice cases and took them into consideration when making a recommendation to the medical executive committee.

Negligent credentialing complexity is often about our failure to be able (after memories have faded) to easily show that we had an effective process, that we followed that process, and that leaders clearly knew about a practitioner’s entire background when making their decisions.

Dotting all the i’s and crossing all the t’s during the initial credentialing process is the best way to avoid credentialing negligence and costly litigation.

Click here for a downloadable PDF of Hugh’s suggestions for a standard of documentation.

Verisys Connect is Verisys’ self-service data search portal that provides real-time data solutions to address background information searches as well as information about past licensure, history or current abuse, exclusions, debarments, disciplinary actions, and sanctions.

A best-practices approach to credentialing is to take the extra steps to see everything about a provider that there is to see. That’s the only way to make sound decisions about who will be entering and representing your institution and caring for your patients.

Also, the e-book, “Closing the Five Critical Gaps in Health Care Screening, Verification and Monitoring for Credentialing” addresses the top typical gaps in health care credentialing and reveals the data solutions that close those danger gaps.

Written by Hugh Greeley Credentialing and Healthcare Industry Expert HG Healthcare Consultant Connect with Hugh