Credentialing accreditation and certification what the radiologist needs to know
Download
1 / 22

Credentialing, Accreditation, and Certification: What the Radiologist Needs to Know - PowerPoint PPT Presentation


  • 62 Views
  • Uploaded on

Credentialing, Accreditation, and Certification: What the Radiologist Needs to Know.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about ' Credentialing, Accreditation, and Certification: What the Radiologist Needs to Know' - zytka


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Credentialing accreditation and certification what the radiologist needs to know

Credentialing, Accreditation, and Certification: What the Radiologist Needs to Know


A Special Thank You to: Dr. David M. Yousem, M.D., M.B.A.
Professor, Department of Radiology
Vice Chairman of Program Development
Director of Neuroradiology
Johns Hopkins Hospitalfor allowing the use of his material/content in this presentationDr. Yousem’s online lecture series can be viewed at:http://webcast.jhu.edu/mediasite/Catalog/pages/catalog.aspx?catalogId=7e18b7d5-9c63-487e-aaf1-77a86f83b011Dr. Yousem’s project was funded through an RSNA Educational Grant


In this presentation we will discuss
In this presentation we will discuss:

  • What is Credentialing? Who provides it and why is it needed?

  • What is Accreditation? What is it important?

  • What is Certification and Maintenance of Certification? How and when is it obtained?


What is credentialing
What is Credentialing?

  • Credentialing is a systematic review process used by a hospital or managed care organization (MCO) to assess and confirm that a physician is competent and qualified to practice medicine in their designated field

  • The landmark Darling v.Charleston Hospital case in the 1960’s established that hospitals had an obligation to verify the competency of the physicians who practice within its walls, and thus credentialing was born


Credentialing committee
Credentialing Committee

  • Each hospital or MCO will have their own credentialing committee

  • The committee is composed of various health care workers: doctors, nurses, physician assistants, administrators, etc. Having a radiologist on the committee is ideal since the committee determines the criteria necessary to grant specific privileges to individual physicians

  • The committee also collects, reviews, and verifies various documents to ensure that a physician meets 6 core competencies: medical knowledge, technical skills, clinical judgment, interpersonal skills, communication skills, and professionalism.


Credentialing support databases
Credentialing Support Databases

  • Committees can use various credentialing support services to verify physician information:

    • National Practitioner Data Bank:

      • Provides information regarding malpractice claims, restrictions of privileges, professional society adverse sanctions, licensure actions by state boards, DEA reports, and CMS exclusion actions. Check your status at www.npdb-hipdb.hrsa.gov

    • Healthcare integrity and Protection databank:

      • Discloses any fraudulent Medicare or Medicaid claims American

    • Board of Medical Specialties:

    • DEA, CDS, Centers for Medicare and Medicaid Services (CMS)


Delay or denial of credentialing
Delay or Denial of Credentialing

  • There are particular RED FLAGS that can delay or deny credentialing:

    • Personal conduct history - Poor references

    • Deferred letters - Alcohol or substance abuse

    • Multiple malpractice suites - Short employment periods

    • Unexplained gaps in employment or education

  • If there is a high risk that credentialing will be denied, it is in the best interest of the physician to resign before the committee investigates or makes their conclusion, as this denial of credentialing will remain on the physician’s permanent record


Delineation of privileges
Delineation of Privileges

  • The Credentialing committee also determines each physicians privileges depending on their specific training and skill level

  • For example, the committee can specify the minimum number of CT, MR, US, myelograms, biopsies, etc that must be read or performed in a specific amount of time to obtain/maintain specific privileges

    • Again, it is important for a radiologist to be on the committee to help determine these criteria

  • These criteria ensure physicians, both radiologist and non-radiologist, are competent in their areas of care


Recredentialing
Recredentialing

  • Once credentialed by a hospital, a physician must apply for recredentialing every 2 years to maintain their privileges


Why is credentialing important
Why is Credentialing Important?

  • A physician MUST be credentialed by a hospital to work there

  • Part of credentialing is delineation of privileges for every hospital staff member, ensuring a physician’s competence in their particular skill set


What is accreditation
What is Accreditation?

  • Accreditation of a health care facility ensures that it is maintaining a high standard for the quality and safety of health care delivery

  • The Joint Commission (formerly the Joint Commission Accreditation of Healthcare Organizations - JACHO) or the American Osteopathic Association (AOA) has the ability to accredit hospitals

    • Periodic inspections and reviews

  • The National committee for Quality assurance (NCQA) is a nongovernment agency that accredits MCO, PPOs, health plans, etc

  • The American College of Radiology (ACR) accredits imaging facilities


Acr accreditation of imaging facilities
ACR Accreditation of Imaging Facilities

  • ACR sets protocols and guidelines for imaging facilities to ensure image quality, equipment, and reporting meet the highest standards in quality and safety

  • ACR evaluates the imaging equipment and the physician in a practice setting

  • This includes radiologists and non-radiologist imagers such as cardiologists, orthopedists, chiropractors, or any physician using imaging equipment in their practice


Acr accreditation
ACR Accreditation

  • Factors evaluated by the ACR:

    • Image quality

    • Film storage and handling

    • Patient identification

    • Right and Left marker placement

    • Written reports

    • Frequency of equipment inspection


Why is acr accreditation important
Why is ACR Accreditation Important?

  • It not only ensures the quality of imaging and reporting but is also REQUIRED by some insurers to be reimbursed

  • Accreditation also restricts non-radiologist from obtaining inadequate images or from obtaining images but not providing written reports

  • More information regarding ACR accreditation can be found on their website, www.acr.org


What is certification
What is Certification?

  • Certification is a lifelong process by which the ABR and/or ABMS ensures that you, as a radiologist are adequately qualified and are involved in continued learning and improvement

  • There are two certification processes, both of which are awarded by the ABR:

    • Initial certification

    • Maintenance of Certification (MOC)


To apply for initial certification you must have
To Apply for Initial Certification you must have:

  • 5 years of approved training

    • 1 year clinical

    • 4 years in Diagnostic Radiology, which includes 4 months of Nuclear Medicine, 3 months of Mammography, and no more than 12 months in any one discipline

  • Passed all ABR examinations

    • Currently: Physics, Written, and Oral Examinations

    • For the 2012 class and forward: a Core examination during R3-R4 year and Certifying examination 15 months after R4 year

  • Cardiac life support certification, high moral and ethical standards, and proof of valid state licensure or Canadian equivalent


Certification and recertification
Certification and Recertification

  • You have a 10 year period after completing training in which to obtain initial certification, which is valid for 10 years

  • You must then apply for Recertification through the ABR and/or American board of medical specialties (ABMS) to continue practicing as a radiologist


Moc recertification
MOC: Recertification

  • To become recertified, you must practice radiology, maintain an active unrestricted license and professional standing, pass the Maintenance of certification (MOC) exam, and meet the following specific requirements over a 10 year period:

    • 250 CME credits - 20 SAM

    • MOC exam - 3 PQI projects


Specific recertification requirements a closer look
Specific Recertification Requirements: A Closer Look

  • 250 category 1 CME credits

    • 70% in a subspecialty or area of practice, 30% general

  • 20 SAM (self assessment modules, each is 90 min)

    • 4 SAM must be in general knowledge, 16 in clinical content

    • At least 6 need to be subspecialty specific

    • May overlap with the CME requirement

    • SAM can be found on the ACR or subspecialty websites

  • MOC examination

    • Comprehensive 4 hr knowledge based computer test

      • 80% clinical content, 20% non-interpretive skills including safety, life support, ethics, physics


Specific recertification requirements a closer look1
Specific Recertification Requirements: A Closer Look

  • 3 PQI (Practice Quality Improvement) projects in 10 years

    • PQI project is a means of self-evaluation and continued quality improvement

    • The project must be in one of these five areas: patient safety, accuracy of interpretation, report timeliness and critical value reporting, referring physician services, practice guidelines.

    • PQI projects can be designed by an individual radiologists, radiology practice groups or departments, institutions, healthcare systems, or by professional radiology societies

    • Every radiologist participating may receive PQI credit for the project

      More PQI information can be found at www.theabr.org


Summary
Summary

  • Credentialing is hospital based process which ensures physician competence and delineates physician privileges

  • Accreditation of a facility by the ACR assures imaging quality standards and is required for insurance reimbursement

  • Certification and MOC by the ABR ensures that radiologists are involved in continuous learning and self-improvement


References
References

  • www.theabr.org

  • www.acr.org


ad