An Overview of Accreditation Knowledge

(45 CEU Credits)

Course Description

Accreditation is an evaluation process by which an institution or organization determines if the standards established by an accrediting body are being met. There are a large number of accrediting and regulatory agencies that impact the healthcare industry.

Every component of the medical staff organization and those providing credentialing services are affected by accreditation, federal and state regulation. Medical services professionals need to have a general understanding of how accrediting and regulatory entities impact their role. They need to know: how governing body and medical staff bylaws are formulated and continually revised to maintain compliance with accreditation standards; how the appointment and reappointment processes must be structured to meet these standards; and how performance improvement and quality issues are a result of these standards.

At the completion of this lesson, you should be able to do the following:

1. Define terminology relative to medical staff appointment and privilege delineation.
2. Identify professional organizations and agencies (including acronyms for organization names) associated with the credentials review process and determination of eligibility for medical staff membership.
3. Define responsibilities and privileges associated with provisional and temporary appointment to the medical staff.
4. Outline a generic procedure for processing application for staff membership and requests for clinical privileges.
5. Flow-chart a credentials review process.
6. List documentation that should be submitted by applicants for evaluation prior to awarding of clinical privileges.
7. Describe the role of the National Practitioner Data Bank (NPDB)/Healthcare Integrity and Protection Data Bank (HIPDB) in the privileges delineation process.
8. Outline a generic reappointment/reappraisal process.
9. Describe the purpose of the medical staff executive committee.
10. Outline department and/or service activities designed to evaluate quality and appropriateness of patient care.
11. Outline the medical staff responsibilities in participating in hospital service departments.
12. Describe the patient care priority focus areas as they relate to the medical staff.
13. Describe hospital activities designed to assess and improve the quality of patient care.
14. Identify the basic components of a written plan to document a Performance Improvement (PI) program in a hospital.
15. Identify hospital leaders responsible for the development, maintenance and ongoing review of performance improvement.
16. Select appropriate reference material to support PI program planning and development.
17. Discuss priority focus areas related to organizational functions.
18. Define the role and function of the National Committee for Quality Assurance (NCQA) and discuss the standards that pertain to credentialing.
19. Outline a generic procedure for processing applications for provider participation and for recredentialing.
20. Flow-chart a managed care credentials review process.
21. List documentation that should be submitted by applicants for evaluation prior to participation approval.
22. Define the role and function of the Utilization Review Accreditation Commission/American Accreditation Healthcare Commission (URAC).
23. Discuss the URAC standards that pertain to credentialing.
24. Describe the URAC accreditation process.
25. Identify the various levels of URAC accreditation.

Time to Complete 90 days

Who Will Benefit? Individuals responsible for staying up-to-date on the accreditation standards of NCQA, JCAHO, and URAC.

Administration and Management
Medical Terminology
Principles of Medical Staff Organization and Healthcare Finance
An Overview of Healthcare Law
An Overview of Managed Care