The largest online database anywhere of free accreditation advice for frontline and management employees in healthcare.
For well over a decade, we've been gathering what we know about accreditation standards and putting that knowledge into plain language. The product of those years of study and writing is this database of accreditation tips. Whenever we learn something new about a standard or the way the reviewers are interpreting it, we update our database.
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IROs must have more rigorous qualifications for reviewers handling appeals. In addition to the requirements outlined in the previous standards, reviewers handling appeals must be board certified, if an MD, DO, or DPM.READ FULL POST
Under this standard, the IRO must establish qualifications for its reviewers. At a minimum, those requirements must include the following:Current, non-restricted license or certificate as required under U.S. law for clinical practice;At least five years FTE experience with direct clinical care;Must be a clinical peer (i.e., "a physician or other health professional who holds an unrestricted licens...READ FULL POST
This standard requires that the IRO have and implement policies and procedures that both require the IRO's staff members to notify the IRO in the event there is an adverse change in the status of the staffer's license or certification (including board certification) andprovide a procedure to implement a corrective action plan in the event of such an adverse change.In other words, if a member of th...READ FULL POST
Under this standard, the reviewer credentialing program must meet the following requirements:primary source verification ("PSV") of any of the required licenses or certifications for clinicians or lawyers;PSV for board certification for board certified MDs, DOs, or DPMs;documented verification of the reviewer's history of disciplinary actions or sanctions; andcollection of information about:the le...READ FULL POST
The standard is for the special situation of a provider whose conduct is so egregious as to give rise to a well-founded concern by your medical director that the provider is posing a threat to the well-being of your members. This is a very important consumer safety standard. Not only must your medical director be freed from the requirement of taking such a dispute through the normal, often slow, d...READ FULL POST
This standard requires that your organization have a mechanism for disputes with providers in your network for largely administrator disputes. Essentially, any provider disputes that are not covered by the previous standard or by the health utilization management appeals standards are covered here.The mechanism that your organization is required to have for such disputes is simply the right to bri...READ FULL POST
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