New Member Resource: NAMSS-ATA Credentialing by Proxy Guidebook

NAMSS is pleased to introduce the NAMSS-ATA Credentialing by Proxy Guidebook, a resource for navigating the credentialing process for practitioners providing remote/telemedicine services. The Guidebook includes a standardized Glossary of Terms, an overview of the existing credentialing process with a focus on telemedicine providers, a review of existing laws and regulations around telemedicine credentialing, a set of guidelines for creating a credentialing by proxy program, and a review of hurdles and potential solutions institutions often encounter with credentialing by proxy.

The Guidebook is the result of a multi-year collaboration between NAMSS and American Telemedicine Association (ATA). In 2017, NAMSS staff and ATA staff convened a joint task force of NAMSS and ATA members to develop a credentialing by proxy guide. Credentialing by proxy is relatively new process by which hospitals using remote practitioners for telemedicine services can accept the remote hospital’s credentialing work, rather than requiring the full traditional credentialing process for practitioners who may never step foot into that facility.

NAMSS and ATA will continue to collaborate to provide resources that facilitate efficient and effective credentialing for institutions and practitioners providing or using telemedicine services. The NAMSS-ATA Credentialing by Proxy Guidebook reflects the current process and credentialing by proxy landscape. NAMSS and ATA will continue to work together to update the Guidebook as necessary and will review the Guidebook on a regular basis to ensure it reflects industry updates.

NAMSS would like to thank the following NAMSS members for their work on the NAMSS-ATA Credentialing by Proxy Guidebook Task Force: 

LouAnn Brindle, MSN, RN, CPCS, CPMSM

Susan Diaz, CPCS, CPMSM 
Beth Erwin, CPCS, CPMS 
Becky Findley, CPMSM, CPCS, FMSP 
Geneva Harris, CPCS, CPMSM 
Lisa "L.J." Jones, CPCS 
Judy Lentz, CPMSM, CPCS 
Diane Meldi, MBA, CPCS, CPMSM 
Kathy Risch 
Linda Waldorf, BS, CPMSM, CPCS

Please contact Molly Giammarco, NAMSS Senior Manager for Policy and Government Relations, with any questions on the Guidebook.

NAMSS Releases its Sixth-Annual Industry Roundtable Report

The 2019 NAMSS Roundtable Report is now available.  NAMSS held its sixth-annual Roundtable discussion with industry stakeholders from 20 organizations including NAMSS on May 9, 2019 in Washington, DC. The past five NAMSS Roundtables have helped institute significant reforms to the credentialing, privileging, and licensure processes. This year’s Roundtable, Credentialing for Tomorrow, facilitated a discussion around adopting a more modern credentialing process while prioritizing patient safety.

The 2019 Roundtable continued to delve into the technology innovations of 2018 with a focused discussion on digitizing credentialing. The report provides an overview of the high-level discussion about how credentialing will evolve as more entities adopt and embrace technology. The report addresses the perspectives of hospitals, practitioners, payers, accrediting bodies, and government oversight entities on the importance of digitizing credentialing and the challenges associated with full adaptation.

Susan Diaz, NAMSS President, moderated the Roundtable presentation and Susan DuBois, NAMSS Government and Industry Relations Liaison, led the Roundtable participants’ discussion. The Report outlines several themes Roundtable participants discussed, including inconsistent enrollment quality standards, the lengthy process of credentialing a practitioner, excessive verification processes, credentialing non-physician practitioners, and institutions unwillingness to invest in credentialing technologies.  

The Roundtable also featured a discussion by FSMB that provided an update on FSMB’s research into digital credentialing, which compared legal, compliance, and technical aspects of digital signatures, open badges, and block chain.

NAMSS led a presentation with participants discussing their main credentialing pain points and potential alternatives or solutions to these pain points. NAMSS will continue to work with Roundtable participants and other stakeholders to develop standards, embrace innovation, and identify credentialing gaps and shortfalls as technology continues to advance.

The following organizations participated in 2019 Roundtable:

•          Accreditation Council for Graduate Medical Education (ACGME)
•          American Association of Nurse Practitioners (AANP)
•          American Academy of PAs (AAPA)
•          American Board of Medical Specialties (ABMS)
•          American Hospital Association (AHA)
•          American Medical Association (AMA)
•          Blue Cross Blue Shield Association (BCBS)
•          Centers for Medicare and Medicaid Services (CMS)
•          Council for Affordable Quality Care (CAQH)
•          DNV GL Healthcare
•          Educational Commission for Foreign Medical Graduates (ECFMG)
•          Federation of State Medical Boards (FSMB)
•          Health Resources & Services Administration (HRSA)
•          Healthcare Facilities Accreditation Program (HFAP)
•          The Joint Commission
•          Medical Group Management Association (MGMA)
•          Nation Council for Quality Assurance (NCQA)
•          National Practitioner Data Bank (NPBD)
•          URAC

ABMS Names Diane Meldi as Stakeholder Council Liaison to the Information and Data Sharing Task Force

NAMSS congratulates Diane Meldi, MBA, CPCS, CPMSM on being named as Stakeholder Counsel Liaison to American Board of Medical Specialties’ Information and Data Sharing Task Force. The Information and Data Sharing Task Force is one of five Task Forces ABMS created to execute its Achieving the Vision plan to develop a continuing certification program that achieves high quality patient-care standards.

The Task Force will develop research and data-sharing strategies to guide future certification assessments, enhance diplomat education, and communicate requirements and standards to strengthen and advance specialty learning and improvement goals. Through collaborations between ABMS Member Boards and key stakeholders, ABMS seeks to learn how continuing certification affects change in diplomat practice, professional development, and patient-care delivery.

As Liaison, Diane hopes to serve NAMSS members by influencing and reporting on ABMS data update frequency and their timeliness of changes. Diane recognizes the challenges and opportunities MSPs have regarding data sharing, “MSPs need to ensure that all data sources are accepted by federal and state regulations and accreditation standards. Additionally, managed care plans need to accurately reflect a physician’s certification status for their marketing materials. Opportunities associated with data sharing are faster verification, lower costs, and the ability to share the importance of physician board certification.”

MSPs can benefit from, and influence, clinical data-sharing processes and policies by demonstrating the role timely and accurate data has in ensuring credentialing excellence and efficiency. Diane’s liaison role will also help show how data sharing can improve the payer and practitioner credentialing processes. “Health care organizations may require certification and recertification and depend on accuracy and timeliness. The number of days to complete the initial credentialing process is getting shorter and shorter. This would ensure that MSPs can get the verifications requested faster.”

The ABMS Stakeholder Liaisons will provide guidance to the Oversight Committee and providing recommendations to the five Task Forces:

• Advancing Practice

• Information and Data Sharing

• Professionalism

• Remediation

•        Standards

The ABMS Commission Task Force Oversight Committee determines each Task Force’s deliverables and timelines. Stay tuned for more updates from Diane Meldi on the progress of the Information and Data Sharing Task Force.

Click here to read the Continuing Board Certification: Vision for the Future Commission's Final Report. Click here to read more about the ABMS Vision Initiative. Click here to read more about the five Task Forces.

NAMSS Updates Ideal Credentialing Standards for Practitioner Applicants

NAMSS has recently released an updated version of the Ideal Credentialing Standards, which outline best practices for the initial credentialing of independent practitioner applicants in medical facilities. The Ideal Credentialing Standards were initially released in 2014, having been developed with a coalition of notable industry representatives across the credentialing ecosystem. In 2019, members of the NAMSS Board convened to review and update the Standards to align with current best practices in the credentialing profession.

The Ideal Credentialing Standards have been recognized as an essential document for determining the gold standard of practitioner credentialing for the past five years. In order to ensure that the Standards remain reflective of the highest level of credentialing practice, NAMSS Board members reviewed the Standards and analyzed new developments in credentialing nationwide. The working group included updates to the standards around identity proofing, education and training, and military service, and revised the list of potential red flags. Additionally, the group detailed recommendations around Internet background checks and social media review, as applicants’ online history continues to be a thorny issue for Medical Staff Offices.

The updated edition of the Ideal Credentialing Standards can be found on the NAMSS website.

GAO Report Reveals VHA’s Need for Improvement in Credentialing and Hiring Process

            A report from the U.S. Government Accountability Office discovered that the Veterans Health Administration had overlooked or missed adverse actions that were reported to the National Practitioner Data Bank (NPDB) while hiring physicians and other healthcare providers. The GAO analyzed healthcare providers at the VHA as of September 2016 who were recorded in NPDB, and found that VHA facilities did not consistently act within VHA employment policies and hired providers with various disqualifying adverse actions.

Staff that were involved in the credentialing and hiring process in at least 5 facilities did not have knowledge of the VHA policy regarding hiring providers with revoked or surrendered licenses due to misconduct or incompetence. VHA officials have stated that they are developing improved processes to verify credentials of providers and ensure they meet all requirements. In December 2017, the VHA conducted a review of all licensed providers and removed 11 that did not meet the licensure requirements, but these reviews are infrequent.

 The GAO made seven recommendations on how the VHA can better their reviewing and hiring process. The recommendations included that the VHA should implement mandatory training periodically for facility staff that is responsible for verifying credentialing and hiring.

Click here for more information regarding the GAO report on VHA.

ABMS Vision for the Future Commission Releases Report on MOC Process

On December 11, 2018, the ABMS Vision for the Future Commission released a report regarding their review of the MOC process. The Commission was tasked with reviewing MOC within the current medical profession and confronted issues that ABMS Boards and Diplomats experience. The Commission addressed areas that are problematic for physicians and provided recommendations for overhauling the MOC system, including retiring the “maintenance of certification” terminology. It remains to be seen what specific changes the ABMS will make to the MOC process, but the commission’s report represents a concerted turn towards real change in the current status quo.

                The Commission also recommended that ABMS boards conduct research to analyze the success of continued certification in helping clinicians provide quality and safe care for their patients. In addition, ABMS should research potential activities that help clinicians maintain their skills. The commission did not directly address fees, yet the survey measured that 58% of doctors said MOC costs were their top concern, 52% said MOC was a burden, and 48% said MOC was not a true reflection of their abilities as clinicians. The Commission report suggested shifting from single point-in-time assessments leveraged years apart to more regular, longitudinal, multi-source assessments to provide more useful appraisals of physicians’ ongoing competence. The report also encouraged medical staff offices and other credentialing professionals not to make credentialing and privileging decisions solely on the basis of certification status, but to utilize certification as an additional data point when evaluating practitioner applicants.

Commission Co-Chairs Christopher Colenda, MD and William Scanlon, PhD told Medscape that while fee structures and pricing were not addressed in the Commission report, they noted that boards should implement reasonable fees. They believe that the changes recommended will enhance the value of the MOC process for all stakeholders. Former NAMSS Presidents, Linda Waldorf and Diane Meldi contributed to the Commission’s work.

Click here to read the Commission’s draft report and here for more information regarding the ABMS commission report on MOC. NAMSS will continue to monitor any further actions of the Commission and changes to the MOC process.

2018 Updates to the NPDB Guidebook

           The Health Resources and Services Administration (HRSA) recently updated its online National Practitioner Data Bank (NPDB) Guidebook on October 26, 2018. This is the first time the Guidebook has been updated since April 2015. The October 2018 Guidebook added a new section titled “Length of Restriction” under Chapter E: Reporting Adverse Clinical Privileges Actions and alters language regarding the reportability of proctoring. The Guidebook also adds seven new questions and answers to the end of Chapter E. Additionally, the Guidebook clarifies that indirect action taken by a physician during an investigation maybe reportable.

            The new section titled “Length of Restriction” states that if a restriction has an adverse effect on a practitioner’s privileges for more than 30 days, then it is reportable on the 31^st day, regardless if the length of the restriction is in writing. The seven new questions that address reporting requirements address the following topics:

1. Agreements not to exercise privileges while under an investigation (Q. 22)
2. Leave of absence while under investigation that restricts privileges (Q.23)
3. Reappointment application review (Q.24)
4. Resignation while subject to a “quality improvement plan” (Q. 25)
5. Restrictions versus generally-applicable guidelines regarding first assistants and practitioner specific requirements (Q.31)
6. A practitioners lapse of privileges at the end of a scheduled term (Q.46)
7. Guidelines on updating NPDB reports modified by Court order (Q.49)

Click here for more information regarding the NPDB Guidebook.