Avoid Negligent Credentialing Consider an automated management system BY TED GOTTIS

Credentialing in ASCs must be done in accordance with best practices and the stan- dards set by the accredita- tion organizations. Failure

to follow these standards consistently, completely and accurately can lead to a negligent credentialing cause of action that calls an ASC’s credentialing process into question.

Such cases can arise when a patient

believes they have received improper care from a non-credentialed physician. Sometimes physicians themselves might think they were not credentialed appro- priately through the same due process as other physicians, resulting in their dis- missal or not being hired. In the event of litigation, the veracity of physician cre- dentialing is heavily scrutinized, which can, in turn, lead to greater exposure and liability for your ASC.

What Leads to a Negligent Credentialing Case? When patients or physicians bring a lawsuit against an ASC, there can be different causes of action, such as bat- tery, assault or tortious interference with a contract between the healthcare pro- vider and ASC. As mentioned above, patients can allege harm from an uncre- dentialed physician or physicians might feel they were unjustly excluded due to an inconsistent credentialing process and bring suit. It is then up to the ASC to demonstrate in court that it has fol- lowed the right steps in its credentialing process in accordance with the accredi- tation organizations.

The Struggle of Spreadsheets For years, the common standard for managing the credentialing process has been through paper documents and spreadsheets in Microsoft Excel. But


With electronic versions of all records automatically filed, securely stored and easily accessible in a centralized location, you can minimize the chances of a negligent credentialing case.”

—Ted Gottis, MedTrainer

for each physician, there can be numer- ous points of information that need to be collected and verified, including medical licenses, peer references/reviews, educa- tion, residencies, malpractice history and employment history.

The sheer amount of information that must be tracked can be daunting for any ASC, regardless of size. Some ASCs may find themselves struggling to handle it all solely through spreadsheets. Today, there are more modern and automated ways to manage the credentialing process.

Modern Technology Is the Best Offense and Defense Beyond having a solid understand- ing of regulations and standards, con- sider a credentialing management sys- tem. Such a system provides a repository to store all information gathered from physicians. With electronic versions of all records automatically filed, securely stored and easily accessible in a cen- tralized location, you can minimize the chances of a negligent credentialing case. Namely, you can monitor against dates and actions, such as expirations or renewals. You can automate all primary source verifications and keep a complete log of verifications. Further, if a suit is brought forth, you have valid documen-

tation and full transparency into your credentialing process to prove you fol- lowed the precise steps and procedures, correctly and consistently. Moreover, automated alerts and emails can notify designated parties— both administrators and physicians—of upcoming expirations and renewals or when information needs to be added or updated. For ASCs with large staff sizes and numerous items to track for hun- dreds of physicians, these systems offer color-coded reports that easily show if any information is expiring, expired or missing, thereby simplifying the creden- tialing process. With constant monitoring through a credentialing management system, you can prevent possible issues if the respon- sible staff member is out of the office and something expires. Traditionally, the issue would not be handled until they returned. Failure to meet such deadlines can lead to challenges with patient care and make an ASC vulnerable to potential litigation during the appeals process with the insurance provider.

In the end, with a proper management system, your ASC is in a better position to provide a solid defense against negli- gent credentialing. Credentialing man- agement systems help you build in neg- ligent credentialing safeguards and are designed to cut down the time it takes to complete the credentialing process, run verifications and maintain up-to-date cre- dentialing of all the physicians who per- form procedures in your ASC. These sys- tems help protect your ASC from liability issues so that you can keep your focus on delivering quality patient care.

Ted Gottis is the senior vice president of MedTrainer, headquartered in Redlands, California, and its QuickCred Division. Write him at

The advice and opinions expressed in this column are those of the author and do not represent official Ambulatory Surgery Center Association policy or opinion.

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