CREDENTIALIN G 101 1

CREDENTIALIN G 101 1

WEEK 5: REAPPOINTMENT, REAPPRAISAL, AND/OR RENEWAL OF PRIVILEGES 2

Ground Rules Participate, Participate, Participate Keep an Open Mind Stay Present Be Respectful Be Brave Ask Questions Have Fun! 3

AGENDA Today we will Review the reappointment, reappraisal and/or renewal of privileges process Discuss reappointment red flags Open discussion 4

REAPPOINTMENT/REAPPRAISAL/RENEWAL RECAP Medical staff must regularly appraise practitioner’s qualifications Conducted at least every 24 months and competence DNV GL follows the CMS regulations while TJC and HFAP require a 2-year reappraisal/renewal. Remember: Reappointment and/or reappraisal (CMS terminology) or renewal of privileges (TJC terminology) 5

REAPPOINTMENT/REAPPRAISAL/RENEWAL RECAP Strategic Operational Plan Timely Reappointment Process Gather clinical activity and complete clinical profile (FPPE/OPPE) Identify Red Flags Assess for competency validation Recommend reappointment only for privileges confirmed for competence 6

REAPPOINTMENT CHALLENGES RECAP Timely completion of the process Low/No Volume Practitioners Developing a Strategic Approach 7

ACTIVITY #14: VERIFICATION With your group, work on completing the Verification Elements Matrix. Instructions: You will be placed in a virtual breakout group of 4-5 To join the virtual breakout, you must select “yes” 10 minutes 80 8

DEBRIEF

DEBRIEF

RED FLAGS Discrepancies between information on reapplication and responses from written/oral verifications Suspended, revoked, reduced: Hospital privileges License DEA Sanctions DEA License Medicare/Medicaid Board Certification 12

RED FLAGS Insurance cancelled/excessive claims, trends of complaints Insufficient performance monitoring/OPPE data Low/no volume practitioner Other? 13

ACTIVITY #15: REAPPOINTMENT DILEMMAS With your group review the case study assigned and answer the question. Instructions: You will be placed in a virtual breakout group of 4-5 To join the virtual breakout, you must select “yes” 10 minutes 83 14

DEBRIEF 15

ACTIVITY #16: CASE STUDY With your group review the scenario assigned and answer the question. Instructions: You will be placed in a virtual breakout group of 4-5 To join the virtual breakout, you must select “yes” 5 minutes 86 16

DEBRIEF 17

OPEN Q&A 18