If you’ve been wondering how healthcare reform will affect your hospital’s credentialing process, part of the answer may lie in new CMS regulations about terminated providers.
Specifically, the Patient Protection and Affordable Care Act of 2010 requires:
The deadline for these changes is January 1, 2011.
Credentialing professionals typically check to see if a practitioner has been excluded from Medicare and Medicaid, but not if he or she has been terminated. However, whether terminated or excluded, the bottom line for hospitals is the same: it can’t collect payments on services that provider performed for Medicare and Medicaid patients.
“Clearly, Congress decided there was a need to strengthen our screening of providers that come into and participate in the Medicaid program,” says Angela Brice-Smith, director of the Medicaid Integrity Group at CMS. “If you look at all the federal health programs, we should all be doing similar things in terms of making sure we have better-performing providers in the programs serving our beneficiaries.”