If NCQA adopts standards, here’s what you’ll need

As more home care networks set up guidelines mirroring those set for physicians by the Washington, DC-based National Committee on Quality Assurance (NCQA), national credentialing of home care providers will become more common.

"It’s an inevitable evolution," says Steven Peskin, MD, medical director for Melville, NY-based Olsten Health Services Network. "As NCQA has matured and has forged physician credentialing and hospital credentialing, looking at home care is an inevitable progression."

Here’s an overview of Olsten’s general credentialing requirements:

1. Application.

All providers must complete the OHS Net work Credentialing Application. The application asks questions about operational, financial, and quality performance information, as well as information related to types of services provided and service areas. The application must contain a current signature of the CEO, administrator, or other appropriate designated representative, attesting that all information provided in conjunction with the application is true and correct.

2. Licensure.

Olsten requires current licensure in good standing in accordance with state statutes. Olsten obtains a copy of the current primary license under which the facility is operating.

3. Medicare/Medicaid sanctions.

Olsten verifies the presence of Medicare/ Medicaid sanctions against a provider by reviewing the most current copy of the Department of Health and Human Services Cumulative Sanction Report. If sanctions are present, then initial credentialing of the provider is ceased. If a provider is currently in the network and sanctions are found, the sanctions are grounds for termination from the network.

4. Proof of professional and general liability insurance.

Each provider must carry general and professional liability coverage. Coverage amounts may vary by state and region. The Network must verify coverage with the provider’s professional and general liability insurance carrier(s). The policy coverage must be current at the time of credentialing.

5. Malpractice history.

The Network medical director will review all malpractice claims settled against the facility to determine whether acceptable risk exposure exists. The review is based on information provided, and attested to, by the provider and information available from the carrier.

6. Accreditation.

The Network verifies current accreditation for all providers that are accredited. For those providers that are not accredited but are Medicare-certified, the Network verifies the current certification. A site visit is required for non-accredited providers. The Network may either perform its own site visit, or defer to the Baltimore-based Health Care Financing Administration (HCFA) site visit, and obtain a copy of said site visit along with any noted deficiencies.

7. QA/QI program.

The Network will obtain a copy of the provider’s QA/QI program and program evaluation.