Medical Staff Services

Credentialing and privileging functions: We have 2 pronged approach – offer our services from initial application to file readiness for credentials committee and MEC. We also offer payer enrollment services that help our clients to submit payer enrollment applications right at the hiring phase which impacts claim submissions and reimbursement by almost 45-30 days.

2nd option we offer is to help hospitals and health-plans established an internal CVO (Centralized Verification Services) to support multi-facilities in their credentialing and enrollment activities in accordance with NCQA standards. We have helped organizations move from paper to paperless environments.

Privilege Development: Review current privilege forms, align them training offered by specialty and recommend edits, change in formats/templates and once approved by MEC and Board, develop and implement a plan for moving each provider to the new format

Peer review design and structure an effective and objective process to help the Peer Review process deliver the ultimate objective of a fair and just review. We help healthcare systems design effective solutions utilizing technology and standard process. Our team has worked with top national legal firms, multi-facility healthcare systems, Rural Hospitals, and Medical Schools with a focus on peer review that encourages learning and encourages the use to experienced clinicians to help navigate challenges. These experiences have helped us build a design and process that is adaptable and flexible in any environment and produce outcomes that stand the test of objective reviews and acceptance by Medical Staff members. This hybrid peer review design helps the committee chairs, department chairs, and ultimately MEC delivers their decision on issues raised via peer review or M&M or OPPE and FPPE quality concerns. Our design includes evidence-based data points, outcomes of RCA’s, and past clinical outcomes within a defined period.

Data-driven OPPE criteria selections that are specialty-specific and utilize in-house EMR and HIM applications, again the flexibility of these solutions are designed based on your organizational structure and available resources. We rely on gap analysis on certain core criteria to assess the most effective solutions for you to measure physician performance as it relates to their peers within their specialty. 

Effective FPPE plans and forms for proctoring a clinician in support of requested privileges

Help train your internal staff, design templates, checklists, and applications that meet State standards.