Credentialing in a Crisis - Business Continuation in the Time of COVID-19 (Part 1)

April 1, 2021
April 1, 2021

By Joe Morris, Writer, HealthStream

The onset of the COVID-19 pandemic meant sudden, dramatic change throughout the world of healthcare. From properly equipping personnel for front-line patient care to conducting back-office business in a virtual setting, every day brought new challenges.

That has certainly been true in credentialing and privileging arena, where virtual processes have been stood up to meet the need, and relaxed governmental regulations have also allowed for workarounds in emergency situations, says Angela Beardsley, BSBS-IT, CPMSM, CPCS, Consultant, Consulting Services at VerityStream.

Temporary and Disaster Privileging

“All our jobs are changing daily, as are the requirements from the federal government,” Beardsley says. “The Joint Commission, HVAC, and DMV all have provisions for some type of temporary privileges: urgent patient care need, low income tenants, temps pending board approval and also for disaster privileges. So, depending on which organization you are accredited by, please make sure to check those standards to see what modified initial and credentialing privileging processes work best for you during this time. It is also imperative to check your organization's medical staff bylaws and policies to ensure that whatever modified process you are considering implementing, it is in alignment with your own organizations’ defined processes.”

Proper Packet Preparation Still Essential for Success

Virtual processes for credentialing reviews and approvals will still utilize packets, and so those must be prepared with the same careful vigilance as always, says Meghan Kurtz, BA, MS, CPCS, Senior Consultant, Consulting Services at VerityStream.

“Whether you're using your own software solution or your manually configuring a PDF package, it’s important to determine what elements are actually going to go into your application packet,” Kurtz says. Packet content should include:

  • Executive summary. A narration of findings, this replaces an in-person conversation that would occur during the meeting during file review. This is the opportunity to communicate any issues that have been found.
  • Profile report. A snapshot of your practitioner. It's going to tell the reviewer about their education, training, certification, affiliations, their work history, their licenses, and claims history, and is usually information obtained from a credentialing database.
  • Pertinent/relevant documents. These are any primary source verifications with issues. Typically flagged items include a state license sanction, or action on the state license or any claims verifications that came back. Include your references and evaluations.
  • Privilege request documentation. Typically the privilege request form.

“When doing these, consider the file size of that packet,” Kurtz advises. “Remember, this is no longer something that they can quickly scan through or you can actually parse out into individual sections with labels. This is going to be one consolidated document. You might be sending that via email, so you want to make sure that it's not too large that it would be rejected. Some items that you’d often want to omit would be additional forms, such as attestation, CME attestations, citizenship attestations and anything that does not really help the reviewer make an informed credentialing decision.”

Learn more about how VerityStream provides Credentialing, Privileging, Enrollment, and Evaluation for Health Systems and Health Plans.