QUESTION:
How far back do we have to go when verifying affiliations for locum tenens physicians during the credentialing process?
ANSWER FROM HORTYSPRINGER ATTORNEY CHARLIE CHULACK:
Unfortunately, there aren’t any hard and fast rules or guidance when it comes to this question. The Joint Commission acknowledged this in an FAQ that was first published on April 11, 2016, by noting that “[t]here is no standard requirement to verify hospital/other healthcare organization affiliations, clinical affiliations, clinical responsibilities, or work history for an applicant.” The FAQ can be found here.
If you are performing delegated credentialing (i.e., payor enrollment), the NCQA standards (which apply to insurers and their delegates) do have a discrete requirement which provides as follows: “The organization obtains a minimum of the most recent 5 years of work history as a health professional through the practitioner’s application or CV. If the practitioner has fewer than 5 years of work history, the time frame starts at the initial licensure date.”
That being said, many hospitals go back ten years when verifying affiliations, and this is the recommendation of at least one national credentialing organization. However, a time frame of ten years can result in a hospital needing to verify an overwhelming number of affiliations for locum tenens who often practice at numerous hospitals each year. Because of this, a hospital may want to focus on and require affiliation verifications for the ten most recent and/or active affiliations for a locum tenens applicant or ten affiliations where the locum tenens had the most activity/practiced for the longest period within the previous ten years. This should give you sufficient information to get a good picture of their practice and if it doesn’t, your policy language should permit you to verify additional affiliations. Finally, remember, if there are any questions or concerns raised about the locums’ practice, you can ask follow-up questions; the burden is on the applicant to provide information to resolve those questions, and their application should be held incomplete until such information is furnished.
If you have a quick question about this, e-mail Charlie Chulack at cchulack@hortyspringer.com