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Understanding CMS Requriements for Credentialing and ...

Understanding CMS Requriements for Credentialing and Privileging Understanding CMS. Requirements for Credentialing , Recredentialing, and Privileging in Hospitals and Managed Care Kathy Matzka, CPMSM, CPCS. 1304 Scott Troy Rd, Lebanon, IL 62254. (618) 624-8124. CMS Hospital CoPs All Interpretative guidelines and manuals are on website Rev. 137, 04-01-15 (most recent hospital). Guidance/Guidance/Manuals/downloads/som1 07ap_a_hos Rev. 110, 10-10-14 most recent CAH. Guidance/Guidance/Manuals/ Most recent rule changes for MS posted in Federal Register May 12, 2014. 2. CMS Hospital Page 3. Kathy Matzka, CPMSM, CPCS 1. Understanding CMS Requriements for Credentialing and Privileging Surveyor & Certification Memos 4. Document Review Hospital and CAH. Medical Staff Bylaws , Rules & Regulations Credential files to determine if the facility complies with CMS requirements and State law, as well as, follows its own written policies for medical staff privileges and Credentialing Personnel files to determine if staff members have the appropriate educational requirements, have had the necessary training required, and are licensed, if it is required (c) Kathy Matzka, CPMSM, CPCS 5.

• CoPs require criteria for determining privileges and for applying the criteria: –Individual character –Individual competence –Individual training –Individual experience –Individual judgment (c) Kathy Matzka, CPMSM, CPCS www.kathymatzka.com 6

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