Physician Credentialing And Peer Review Answer Book

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Physician Credentialing And Peer Review Answer Book

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Author : Patricia A. Younger
language : en
Publisher: Aspen Publishers
Release Date : 1995

Physician Credentialing And Peer Review Answer Book written by Patricia A. Younger and has been published by Aspen Publishers this book supported file pdf, txt, epub, kindle and other format this book has been release on 1995 with Hospitals categories.

Find the answers to questions most often asked by hospitals regarding the mechanics of the Credentialing process, such as involvement of the medical staff, board of trustees, and administrative personnel. It also guides the decision maker regarding the subjective judgment calls required during the process, such as whether to hire a practitioner who has a disciplinary history, what privileges to grant during the provisional period, and how to conduct the reappointment process. Includes state-by-state breakdown of laws applicable to discoverability and admissibility of medical staff committee records. Lists 350 questions, categorized by topic, with answers immediately following. Appendix lists each statute and regulation.

The Credentialing Handbook

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Author : Sheryl Deutsch
language : en
Publisher: Jones & Bartlett Learning
Release Date : 1999

The Credentialing Handbook written by Sheryl Deutsch and has been published by Jones & Bartlett Learning this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999 with Allied health personnel categories.

The Credentialing Handbook provides comprehensive, plain-English guida nce to understand and master the provider credentialing process in any health care setting. With sample forms, checklists, flowcharts, and c orrespondence, this practical guide walks you through every aspect of effective credentialing, appointment, and recredentialing. You'll lear n: key steps in the credentialing process; about express credentialin g models; how to credential allied health practitioners; typical time frames and tracking systems; pros and cons of delegating credentialin g, plus more.

Peer Review Quality Committee

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Author : Richard A. Sheff
language : en
Publisher: Hcpro, a Division of Simplify Compliance
Release Date : 2012

Peer Review Quality Committee written by Richard A. Sheff and has been published by Hcpro, a Division of Simplify Compliance this book supported file pdf, txt, epub, kindle and other format this book has been release on 2012 with Institutional review boards (Medicine) categories.

Get the knowledge needed to serve as an effective Peer Review & Quality Committee member and fulfill the role well. Peer Review & Quality Committee Essentials Handbook compares and contrasts the traditional and contemporary definition of peer review and offers strategies to initiate focused professional practice evaluation based on peer review activities. This handbook can be used as a comprehensive guide for peer review & quality committee members, providing them with the necessary knowledge and skills to perform their role effectively. Plus, to make staff training easy, this handbook includes a customizable PowerPoint(R) presentation highlighting key takeaways covered in the handbook. Benefits of Peer Review & Quality Committee Essentials Handbook: Earn CE and certification credits Assess, document, and comply with The Joint Commission's core competencies Verify the competence of advance practice professionals and allied health professionals Understand the role of physician leaders in focused professional practice evaluation (FPPE), ongoing professional practice evaluation (OPPE), and peer review Overcome challenges presented by low- and no-volume providers and legal issues such as negligent credentialing Avoid costly, time-consuming fair hearings Oversee professional conduct and confront disruptive behavior What's inside: Compare and contrast the traditional and contemporary definition of peer review Measure performance by selecting performance targets based on the core competencies Explain eight key steps in conducting effective case review Recognize all levels of performance data with normative data Initiate focused professional practice evaluation based on peer review activities Define discoverability and immunity Derive strategies to streamline peer review and quality meetings Table of Contents Chapter 1: Roles and responsibilities of peer review and quality committees Chapter 2: Selecting physician performance measures and targets Chapter 3: Effective case review Chapter 4: Aggregate data collection and evaluation for OPPE Chapter 5: FPPE for performance concerns Chapter 6: Ethical and legal issues of discoverability, conflict of interest, and confidentiality Chapter 7: Effective peer review

Medical Staff Peer Review

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Author : Daniel A. Lang, MD
language : en
Publisher: Jossey-Bass
Release Date : 1999-10-15

Medical Staff Peer Review written by Daniel A. Lang, MD and has been published by Jossey-Bass this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999-10-15 with Health & Fitness categories.

The key to patient safety and improved efficiency of care is the proper evaluation of individual professional performance. Co-published with the American College of Physician Executives, this newly revised edition provides tools and strategies for the performance of effective peer review. Whereas the first edition focuses on peer review of the acute care hospital medical staff, this edition broadens the approach to include ambulatory and post acute delivery settings. It updates and expands the technical and organizational tools available to those who are faced with the need to find ways to improve clinical performance. Chapters include: -Tools for the initial evaluation and credentialing of physicians -Sample physician performance profiles -Techniques for determining clinical privileges of a physician at initial appointment and re-appointment -Making medical personnel decisions -Ethical dimensions of physician performance -Implications of adverse peer review beyond the hospital medical staff -Methods for distinguishing between system and practitioner performance problems

Ahla Peer Review Guidebook Ahla Members

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Author : Barbara Blackmond
language : en
Publisher:
Release Date : 2016

Ahla Peer Review Guidebook Ahla Members written by Barbara Blackmond and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 2016 with categories.

The newly updated Fifth Edition of Peer Review Guidebook is a comprehensive resource for understanding the peer review process and disciplinary proceedings involving physicians.Peer review in the health care setting has numerous elements, and while there are few fixed definitions, the essence of the process addresses physician credentialing, privileging, and professional evaluation, both ongoing and focused practice evaluation. Health care entities conduct peer review for multiple reasons, including improvement of care, protection of patients from harm, and improvement of physician performance. While the initial process begins when a practitioner applies to be a member of the medical staff or gain privileges at a hospital or other health care provider, latter elements can include potential reduction or denial of privileges to those under review. The critical guidance for peer review is found in the Health Care Quality Improvement Act (HCQIA), which offers immunity from monetary damages for those individuals and institutions that participate in an adverse professional review action relating to the competence or professional conduct of a physician, provided that its procedural requirements are followed.Edited by Barbara Blackmond, Charles J. Chulack, Joshua A. Hodges, Lauren M. Massucci and Daniel Mulholland, this updated edition contains information about HCQIA and its impact on the peer review process, suspension of privileges, injunctive relief from peer review actions and the effect of the privacy rule of the Health Insurance Portability and Accountability Act on peer reviews. The title also provides a multitude of citations to cases, regulations, and other sources. In addition, the appendices include a listing of cases in which physicians have alleged violations of the American Disabilities Act, cases dealing with physician-behavior issues, a comprehensive list of exclusive-contract case law, cases decided under HCQIA , and numerous others that address the peer review process.The eBook versions of this title feature links to Lexis Advance for further legal research options.

Physician Assistant Legal Handbook

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Author : Patricia A. Younger
language : en
Publisher: Jones & Bartlett Learning
Release Date : 1997

Physician Assistant Legal Handbook written by Patricia A. Younger and has been published by Jones & Bartlett Learning this book supported file pdf, txt, epub, kindle and other format this book has been release on 1997 with Law categories.

This book, written for PAs, PA students, institutional and physician e mployers of PAs, and health care lawyers, is a comprehensive reference on laws impacting physician assistant practice. In addition to offeri ng a detailed account of the evolution of the PA profession, including its continuing expansion in today's health care environment, this boo k provides thorough coverage of a wide range of legal issues related t o the PA practice; including academic training and certification, lice nsure, scope of practice and prescriptive authority, employment laws, peer review and credentialing, malpractice, risk management, professio nal liability insurance, medical records, reimbursement, ethics, and e mployment issues related to PAs in hospitals and other practice settin gs.

Managed Care Answer Book

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Author : Sheryl Tatar Dacso
language : en
Publisher:
Release Date : 1999

Managed Care Answer Book written by Sheryl Tatar Dacso and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1999 with Business & Economics categories.

This is an indispensable reference for all professionals involved in the design, implementation, financing, or operation of a managed care program, written in the classic answer book format. You'll find extensive sections providing basic understanding of managed care, cost containment strategies, and advice on organization and implementation of programs. The topic is covered from the ground up, with crucial questions and authoritative, up-to-date answers on every facet of managed care, including such valuable features as: Contract negotiation strategies and dispute resolution techniques Maximizing utilazation review and outcomes assessment Techniques for managed care implementation and administration Plus payer and provider contracting; advice on legal and regulatory considerations; important issues covered from both purchaser's and provider's perspectives; and discussion on information technology and telemedicine.

Answers To 20 New Tough Questions About Medical Staff Bylaws Credentials And Peer Review

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Author : Richard E. Thompson
language : en
Publisher:
Release Date : 1987

Answers To 20 New Tough Questions About Medical Staff Bylaws Credentials And Peer Review written by Richard E. Thompson and has been published by this book supported file pdf, txt, epub, kindle and other format this book has been release on 1987 with Hospitals categories.

Effective Peer Review

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Author : Robert J. Marder
language : en
Publisher: Hcpro, a Division of Simplify Compliance
Release Date : 2013

Effective Peer Review written by Robert J. Marder and has been published by Hcpro, a Division of Simplify Compliance this book supported file pdf, txt, epub, kindle and other format this book has been release on 2013 with Professional standards review organizations (Medicine) categories.

Effective Peer Review The Complete Guide to Physician Performance Improvement, Third Edition Robert J. Marder, MD Peer review continues to rate as a top problematic issue in healthcare organizations. Even if they are meeting regulatory standards, most organizations struggle to develop a peer review program that is meaningful to physicians, causing them to become resistant to this performance measurement tool. This new edition explains the connection between peer review, OPPE, and FPPE. It also contains updated information on OPPE and FPPE as related to The Joint Commission''s standards. This book also incorporates three previous books: Effective Peer Review, Peer Review Best Practices, and Measuring Physician Competency. Now readers have one, all-encompassing resource to answer their peer review and physician performance questions. This completely updated book will help you: Engage physicians in the peer review process Create tools to recognize and celebrate excellence Design OPPE profiles and create a plan for distributing the information to physicians Eliminate bias and improve case reviewer efficiency Determine if your peer review policies comply with regulatory standards Take a look at the Table of Contents: Chapter 1: Peer Review: Why Do We Need to Measure Physician Competence? What Peer Review Is What Peer Review Is Not Who Is a Peer? Impartiality and Conflicts of interest Sham Peer Reviews The Duty to Perform Effective Peer Review Should Physicians Be Paid to Perform Peer Reviews? Chapter 2: From Punitive to Positive: Creating a Performance Improvement Culture for Peer Review How Can Culture Change? Values of a Performance Improvement-Focused Peer Review Culture Peer Review and the Just Culture Chapter 3: Legal Considerations: Impact of Regulations and Liability on Peer Review Redefining Peer Review: OPPE, FPPE, and the Core Competencies How the Standards Apply Peer Review Protection Laws Affirmative Duty to Keep Information Confidential Fair Hearings The National Practitioner Data Bank Negligent Peer Review Chapter 4: Peer Review Structures: The Impact of Multi-Specialty Peer Review Peer Review Structures: Three Primary Functions Goals for Peer Review Redesign Basic Peer Review Models Who Should Oversee Peer Review? Selecting the Right Model Physician Behavior: Who Should Handle It? Chapter 5: Measuring Physician Performance: What to Measure and How to Do It Fairly? What Is a Physician Performance Indicator? Indicator Validity: Selecting Physician-Driven Measures What Are You Required to Measure? What to Measure: Structure, Process, and Outcome How to Measure Physicians Fairly: Review, Rate, and Rule Indicators Understanding and Improving Risk- Adjusted Data Using Perception Data to Evaluate Physician Performance Case Study Indicator Selection Chapter 6: Case Review: Reducing Bias and Improving Reviewer Efficiency and Effectiveness Standardizing the Case Review Process Case Identification and Screening Physician Reviewer Assignment Physician Review and Initial Case Rating Initial Committee Review and Physician Input Committee Decision and Improvement Opportunity Identification Communication of Findings and Follow-Up Accountability Case Rating Systems Case Review and the Electronic Age Chapter 7: Selecting Physician-Driven Measures for OPPE: Understanding and Applying the Six Core Competencies ACGME, ABMS, and The Joint Commission: Where Did the Core Competencies Come From and How Are They Used? Alternative Frameworks to the Core Competencies Using the Competency Statement and Expectations to Drive Physician Performance Measures Applying the Core Competencies to OPPE Chapter 8: Physician Data Attribution: Making OPPE Data Meaningful to Individual Physicians Using Imprecise Data for OPPE Attribution and Case Review Improving Attribution for Process Measures Outcome Measure Attribution in a Multiple-Provider World Attribution and Patient Satisfaction Data Chapter 9: Evaluating OPPE Data: Using Benchmarks and Targets for FPPE and the Pursuit of Excellence Understanding Normative Data Interpreting OPPE Data for a Time Interval How to Set Indicator Targets Targets for Indicator Types Interpreting OPPE Data for Trends Chapter 10: From OPPE to FPPE: Creating Accountability for Physician Performance Improvement Accountability for FPPE Initiation, Monitoring, and Follow-Up Designing an Effective FPPE Plan Getting Physician Buy-In for Improvement Opportunities and FPPE What Happens If FPPE Fails? Chapter 11: OPPE Profiles and Physician Performance Feedback: Practical Principles for Competency Report Design and Distribution OPPE Profile and Physician Performance Feedback Report: What Is the Difference? Designing the Report Define the Principles: 10 Questions to Guide Your Design Create a Format That Reflects the Design Principles Preparing and Distributing Competency Data Reports Develop the Infrastructure and Support Materials Pilot-Test Your Design Create a Policy for Physician Competency Reports Chapter 12: External Peer Review in a Physician Improvement Culture EPR Uses The EPR Policy What Circumstances Typically Require EPR? Who Determines When EPR Is Needed? Who Will Select the Reviewer? How Will the Cases Be Selected? Who Will Review the EPR Report Findings? How Will the Results Be Used? Beyond Case-Based EPR: Physician Assessment Programs Chapter 13: Reporting Peer Review: What Does the Board Need to Know? Contemporary Board Accountabilities for Hospital Quality What Keeps the Board Awake at Night? Filling In the Knowledge Gap: Helping Boards Understand Physician Competency Measurement What Data Should the Board Get? Chapter 14: Running an Effective Peer Review Committee Meeting Elements of an Effective Meeting Role of the Committee Chair Responsibilities of Committee Members in Meeting Preparation and Management Practical Tips for Managing Committee Discussion to Avoid Wasting Physician Time Chapter 15: Beyond the Hospital Walls: Peer Review in Ambulatory Care and ACOs Why Would You Want to Do Peer Review in a Nonhospital Setting? Can You Do Peer Review in the Nonhospital Setting? What Data Can You Obtain From the Hospital and What Are You Willing to Share? Peer Review Outside the Hospital: How Should You Organize It? Peer Review Outside the Hospital: What Can You Measure? Chapter 16: Creating Effective Peer Review Policies and Procedures What Do Your Policies and Procedures Need to Cover? Redesigning Your Peer Review Program: A Step-by-Step Guide Should You Do This Yourself or Get Some Help?

Effective Peer Review

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Author : Robert J. Marder
language : en
Publisher: HC Pro, Inc.
Release Date : 2007

Effective Peer Review written by Robert J. Marder and has been published by HC Pro, Inc. this book supported file pdf, txt, epub, kindle and other format this book has been release on 2007 with Business & Economics categories.

HCPro is pleased to introduce Effective Peer Review: A Practical Guide to Contemporary Design, Second Edition, authored by The Greeley Company experts, Robert J. Marder, MD and Mark A. Smith, MD, MBA, FACS. Completely updated to help you: * Comply with The Joint Commission's 2007 standards * Deliver focused and ongoing professional practice evaluations * Evaluate physician core competencies * And much more! Peer review continues to rate as a top problematic issue and one you can't ignore. The pressure is driven by publicly available national data, The Joint Commission's 2007 standards expanding measurement of physician competence, and hospital boards' need to be assured that the peer review process is functioning effectively. Learn how to go beyond just satisfying a regulatory requirement to performing peer review that fosters true improvement within your facility. Although hospitals go through the motions of peer review, they are often unable to make it a meaningful process-one that results in true improvement in physician performance and meets The Joint Commission's standards. Transform your peer review process and meet external requirements with Effective Peer Review: A Practical Guide to Contemporary Design, Second Edition. Get best practices to make peer review worthwhile Newly updated and in high demand, Effective Peer Review, Second Edition, outlines and provides advice about how to do physician peer review effectively. Authored by experts from The Greeley Company, this book and CD-ROM goes beyond just reviewing the Joint Commission standards. It puts the standards in context by emphasizing best practices you can implement in your peer review process. Plus, you'll receive thorough discussion about data analysis and collection, along with peer review scoring and rating systems. Critical information at your fingertips Offering step-by-step guidance to peer review, this book and CD-ROM will help you: * Streamline your exist