Thursday, April 29, 2010

Missouri Legislation Proposes 45-Day Credentialing Window

Missouri House Bill 2450 (HB 2450), the "Prompt Credentialing Act," would require every health carrier in the state to complete verification of a physician's credentials and to make a credentialing decision within 45 days after receiving a complete application. If a decision is not made within the timeframe, then the health carrier must grant provisional credentialing status until a final determination is made. The bill also requires health carriers to retroactively compensate physicians for services rendered since the date of his or her application.

Making credentialing decisions more efficient is certainly a positive step. However, did lawmakers adequately consider the factors that play into the credentialing process when setting this timeframe? For example, hospitals with a delegated agreement would have a hard time meeting a 45 day timeframe. Also, the 45 day window doesn't encourage physicians to complete the application any faster, since it is imposed on the credentialing verification process.

Finally, what if additional investigation needs to be done on a physician's record and the 45 day timeframe lapses? Are hospitals comfortable with having a member on the medical staff with provisional status if they are still investigating a possible "gap" in his or her file?

NAMSS will work with members in Missouri to ensure that any concerns are communicated to lawmakers before this piece of legislation is voted upon. The bill currently has a proposed effective date of August 2010.

What are your thoughts on this issue? Do you have a credentialing timeframe in your state? If so, how long is it, and have you run into any problems because of it? Share your thoughts in the comment field below this post on the NAMSS Blog website.

To read Missouri HB 2450, click here:


Unknown said...

If you have an applicant with an accusation against their MD license, DEA, Medicare, etc. – or with a DUI or other criminal conviction, there would not be time to conduct a thorough review. It takes a while for the legal process to sort through pending issues and it would be a disaster to grant Provisional privileges before getting to the bottom of the matter. In order to meet the timeline, a hospital may grant privileges to an unsafe provider and this would create a risk to patients.

In addition, this 45-day period would be inadequate if a hospital received applications from a telemedicine group with a large number of providers who all need to be credentialed at the same time.

In order to meet the timeline, hospitals would need to take shortcuts that would undermine the safe provision of patient care. If the legislation is enacted, hospitals may need to change Bylaws to exclude physicians with any kind of malpractice case, criminal conviction, foreign training in order to ensure that the timeline is met.

Medical Staff Offices are already chronically overworked and short-staffed and adding impossible deadlines may make trained professionals leave the field, thus worsening the problem.

Thelma said...

Yes, we have just been approached by the telemedicine group reducing their available physicians from 200 to just 20 who will directly provide service to us. We will be accepting their delegated credentialing packet because of the impossibility of credentialing all the telemedicine physicians in a timely manner.
I agree that patient safety is a concern and that a 45-day limit is too short. NCQA and URAC standard specify a credentialing timeframe maximum of 180 days. So, why has Missouri State put the burden on the med staff office?

Cathy said...

When I read this bill, I interpreted it that it pertains to only health insurance plans. It states "Health benefit plan" and "Health carrier". It doesn't mention hospitals at all. I work for a multi-speciality physician practice and when it comes to credentialing with insurance plans, it can be a nightmare. Some plans can take 6 months or longer to credential a physician. This is unacceptable when you have a physician ready to start working, but can't see patients. I personally think this is a good recommendation as I believe it is only for the health insurance plans credentialing and NOT for hospital credentialing.