Case Closed
This process is initiated when a provider is granted new privileges or when concerns arise about their competence, requiring close performance monitoring.
What is Focused Professional Practice Evaluation (FPPE)?
This form is used to verify provider malpractice insurance.
What is a Certificate of Insurance (COI)?
This organization verifies a provider's credentials during the Medicare enrollment process.
What is the Medicare Administrative Contractor (MAC)?
The process by which a hospital grants specific clinical duties to a provider is called this.
What is privileging?
This is the highest level of nursing practice, often requiring a doctoral degree.
What is a Nurse Practitioner (NP) or Doctor of Nursing Practice (DNP)?
Hospitals use this ongoing process to evaluate a provider’s clinical performance and competency over time.
What is Ongoing Professional Practice Evaluation (OPPE)?
Hospitals must request and review this document from previous employers to assess provider history.
What is a work history verification or employment verification letter?
Before a provider can see Medicaid patients, they must enroll with this state-specific entity.
What is the State Medicaid Agency?
Before granting privileges, hospitals must assess a provider's qualifications using this set of criteria.
What are education, training, experience, and current competency?
A CRNA is a specialized nurse in this field.
What is anesthesia?
If a provider’s FPPE reveals deficiencies, the hospital may implement this type of plan to support improvement.
What is a performance improvement plan (PIP)?
This document is required for Medicare enrollment and often for hospital credentialing.
What is a CMS-855 application?
To enroll with commercial insurance companies, providers must complete this type of application.
What is a payer enrollment application?
Privileges have historically reviewed and renewed on this schedule, prior to the change made by The Joint Commission in 2022.
What is every two years (biennially)?
Physician Assistants and Nurse Practitioners are both categorized as this type of provider.
What is an Advanced Practice Provider (APP)? (formerly AHP)
The Joint Commission requires hospitals to use FPPE and OPPE as part of this broader function to ensure patient safety and quality care.
What is the credentialing and privileging process?
State licensing boards require this document to verify a physician's completion of residency.
What is a residency completion certificate?
Many private payers require credentialing through this centralized system.
What is CAQH ProView?
This process is used to monitor a newly privileged provider's performance.
What is Focused Professional Practice Evaluation (FPPE)?
This term broadly refers to (all) doctors who focus on diagnosing and treating patients but do not perform surgery.
What is a physician (MD/DO)?
If a provider fails to meet performance expectations despite remediation efforts, the hospital may take this final step, which must follow due process guidelines.
What is revocation or non-renewal of privileges?
To verify a physician's board certification, you would contact this organization.
What is the American Board of Medical Specialties (ABMS) or the American Osteopathic Association (AOA)?
If a provider forgets to update their credentialing information with a payer, this might happen.
What is claim denials or termination from the network?
If a provider requests privileges outside their specialty, they may need to submit this type of evidence.
What is documentation of additional training or proctoring?
These healthcare professionals specialize in assisting in surgeries and wound closure.
What are Surgical Assistants or First Assistants?