EMTALA Emergency Medical Treatment and Active Labor Act
HCQIA Health Care Quality Improvement Act of 1986
HFAP Healthcare Facilities Accreditation Program
NCQA National Committee for Quality Assurance
URAC Used to stand for Utilization Review Accreditation Commission; now it just known as
URAC.
AAAHC Accreditation Association for Ambulatory Health Care
USMLE United States Medical Licensing Examination
UPIN Unique Physician Identification Number
OIG Office of Inspector General
NTIS National Technical Information Services
NPDB National Practitioner Data Bank
NPI National Provider Identifier
MCO Managed Care Organization
HIPAA Health Insurance Portability and Accountability Act of 1996
HEDIS Healthcare Employers Data Information Set
FSMB Federation of State Medical Boards
FCVS Federation Credentials Verification Service
FACIS Fraud and Abuse Control Information System
CVO Credentials Verification Organization
, CMS Centers for Medicare and Medicaid Services
ADA Americans with Disabilities Act
Appointment time frame - TJC Not to Exceed 24 months
Appointment time frame - CMS Medical staff must approve at regular intervals; in absence of state law, CMS recommends at
least every 24 months. Surgical privileges should be reviewed at least every 2 years.
Appointment time frame - AAAHC As defined by state law and organizational policy; not to exceed 3 years.
Appointment time frame - URAC At least every 3 years, counted to the month.
Complaints - TJC There must be a process for evaluation of the credibility of a complaint, allegation, or
concern against a privileges provider. For telemedicine, the complaint is reported to the
distant site by the originating site.
Applicant Identity - TJC There must be a mechanism to determine the identify of the applicant.
* view current hospital ID card
* view current state/federal issued photo ID
Applicant Identity - HFAP, DNV, URAC, AAAHC, CMS Not specifically addressed
Appointment time frame - DNV As defined by state law; not to exceed 3 years
Appointment time frame - HFAP At least every 24 months based on CMS standards
Appointment time frame - NCQA Every 3 years, counted to month
Ability to Perform Clinical Privs (Health Status) - CMS Not specifically addressed, but surveyors are instructed to review the hospital's method for
reviewing surgical privs, which require a written assessment of practitioner's training,
experience, health status, and performance.
Ability to Perform Clinical Privs (Health Status) - AAAHC The organization must require and review pertinent info concerning the applicant's physical
and mental health or chemical dependency that would interfere with the ability to provide
high quality patient care or services.
Ability to Perform Clinical Privs (Health Status) - URAC The application includes disclosure of any physical, mental, or substance abuse problems
that could, without reasonable accommodation, impede the practitioner's ability to provider
care according to the accepted standards of professional performance or pose a threat to the
health or safety of patients.
Ability to Perform Clinical Privs (Health Status) - DNV Not specifically addressed, but surveyors are instructed to review the hospital's method for
reviewing surgical privs to determine if the process requires verification of training,
experience, health status, and performance
Ability to Perform Clinical Privs (Health Status) - HFAP Health status is considered for each applicant and reapplicant during the review and
approval process.
* For reapp: can come from peer, peer review committee, reviews by Creds, Chair, or MEC
* References should include a statement re: physical and mental health in relation to privs
requested.
Ability to Perform Clinical Privs (Health Status) - NCQA There is a current, signed attestation statement from the applicant re: the reasons for any
inability to perform the essential functions of the position, with or without accommodation,
and the lack of present illegal drug use.
Ability to Perform Clinical Privs (Health Status) - TJC Applicant's ability to perform privs requested must be evaluated and documented in
credentials file.
*Applicant must submit statement that no health problems exist that could affect exercise of
privs
*Initial App: Statement should be confirmed by director of training, chief of staff, etc.
*Status must be evaluated prior to recommending privs
HCQIA Health Care Quality Improvement Act of 1986
HFAP Healthcare Facilities Accreditation Program
NCQA National Committee for Quality Assurance
URAC Used to stand for Utilization Review Accreditation Commission; now it just known as
URAC.
AAAHC Accreditation Association for Ambulatory Health Care
USMLE United States Medical Licensing Examination
UPIN Unique Physician Identification Number
OIG Office of Inspector General
NTIS National Technical Information Services
NPDB National Practitioner Data Bank
NPI National Provider Identifier
MCO Managed Care Organization
HIPAA Health Insurance Portability and Accountability Act of 1996
HEDIS Healthcare Employers Data Information Set
FSMB Federation of State Medical Boards
FCVS Federation Credentials Verification Service
FACIS Fraud and Abuse Control Information System
CVO Credentials Verification Organization
, CMS Centers for Medicare and Medicaid Services
ADA Americans with Disabilities Act
Appointment time frame - TJC Not to Exceed 24 months
Appointment time frame - CMS Medical staff must approve at regular intervals; in absence of state law, CMS recommends at
least every 24 months. Surgical privileges should be reviewed at least every 2 years.
Appointment time frame - AAAHC As defined by state law and organizational policy; not to exceed 3 years.
Appointment time frame - URAC At least every 3 years, counted to the month.
Complaints - TJC There must be a process for evaluation of the credibility of a complaint, allegation, or
concern against a privileges provider. For telemedicine, the complaint is reported to the
distant site by the originating site.
Applicant Identity - TJC There must be a mechanism to determine the identify of the applicant.
* view current hospital ID card
* view current state/federal issued photo ID
Applicant Identity - HFAP, DNV, URAC, AAAHC, CMS Not specifically addressed
Appointment time frame - DNV As defined by state law; not to exceed 3 years
Appointment time frame - HFAP At least every 24 months based on CMS standards
Appointment time frame - NCQA Every 3 years, counted to month
Ability to Perform Clinical Privs (Health Status) - CMS Not specifically addressed, but surveyors are instructed to review the hospital's method for
reviewing surgical privs, which require a written assessment of practitioner's training,
experience, health status, and performance.
Ability to Perform Clinical Privs (Health Status) - AAAHC The organization must require and review pertinent info concerning the applicant's physical
and mental health or chemical dependency that would interfere with the ability to provide
high quality patient care or services.
Ability to Perform Clinical Privs (Health Status) - URAC The application includes disclosure of any physical, mental, or substance abuse problems
that could, without reasonable accommodation, impede the practitioner's ability to provider
care according to the accepted standards of professional performance or pose a threat to the
health or safety of patients.
Ability to Perform Clinical Privs (Health Status) - DNV Not specifically addressed, but surveyors are instructed to review the hospital's method for
reviewing surgical privs to determine if the process requires verification of training,
experience, health status, and performance
Ability to Perform Clinical Privs (Health Status) - HFAP Health status is considered for each applicant and reapplicant during the review and
approval process.
* For reapp: can come from peer, peer review committee, reviews by Creds, Chair, or MEC
* References should include a statement re: physical and mental health in relation to privs
requested.
Ability to Perform Clinical Privs (Health Status) - NCQA There is a current, signed attestation statement from the applicant re: the reasons for any
inability to perform the essential functions of the position, with or without accommodation,
and the lack of present illegal drug use.
Ability to Perform Clinical Privs (Health Status) - TJC Applicant's ability to perform privs requested must be evaluated and documented in
credentials file.
*Applicant must submit statement that no health problems exist that could affect exercise of
privs
*Initial App: Statement should be confirmed by director of training, chief of staff, etc.
*Status must be evaluated prior to recommending privs
