Red Flags

Description

Shades of Concern: Unpacking Credentialing Red Flags
Credentialing red flags can range from straightforward issues to complex scenarios with significant legal implications. Join TMG to explore the subtler, more legally complex red flags such as discrepancies in licensure across states, unusual patterns in malpractice settlements, and ambiguous peer review outcomes. Learn how to navigate these gray areas, understanding their legal contexts and the proactive steps needed to address them.

Objectives:
Identify credentialing red flags that require legal insight
Describe the legal implications of complex red flags and lawful handling within credentialing
Explain strategies for documenting and managing complex red flags

Integrity & Ethics: Reporting Poor Provider Behavior
MSPs play a key role in ensuring that poor provider behavior is handled in accordance with policies, medical staff bylaws, and the law. Join TMG for hypothetical cases and the MSP’s legal and professional responsibilities in each.

Objectives:
Describe 3 strategies to work in alignment with the organization’s/medical staff legal counsel
Confirm behavior types that require a report to the NPDB
Identify how an MSP can protect the integrity of the reporting process

Tapping the Brakes: Recognizing Credentialing Red Flags

When a credentialing specialist discovers an anomaly in a provider’s application – such as time gaps, malpractice issues, and reporting inconsistencies – it sends up a red flag. Join Team Med Global in discussing how to handle areas of concern that surface in applications for membership and privileges.

Objectives:
Explain the concept of negligent credentialing
List 5 types of issues flagged by credentialing specialists
Describe 4 steps to take when red flags surface