Navigating the mountain of paperwork with your first hospital-based job

[JenGintheED]

I encountered an overabundance of paperwork this past year, first in getting hired and then with hospital credentialing. I spent a lot of time researching how to get a DEA number… what’s an NPI and do I need one… everything I’ve done in the last 15 years plus documentation to support it. After two employer packets and eight hospital credentialing packets, I finally have a notebook with everything in it (I think :rolleyes: ). Along the way, I’ve had new grads ask me some of the questions I had to work out… so here is a list of what’s in my notebook and how I acquired each. Commentary, especially state-specific and from those with more experience, is greatly encouraged.

 

Personal identification: State driver’s license, social security card, wallet-sized head-shot photos with name and contact info on the back.

 

Copy of most recent CV

 

State license: Arizona issues a wallet card and certificate. Some wanted the wallet card (front and back), others wanted the full certificate. What the heck – copy 'em both.

 

DEA certificate: You do NOT need to be licensed to start the registration process. The registration specialist at our local office told me that the process could be expedited by filing the application incomplete – so I actually filed prior to graduating. It takes 4-6 weeks to process once all the requirements (i.e. licensing) are met. You will need a separate registration for each state you will be practicing in. Each registration costs $551. The standard period of registration is 3 years. However, the website states that the initial registration period can range from 28 to 39 months. Go to http://www.deadiversion.usdoj.gov/online_forms.htm to apply and pay online. Click on ‘new registration applications’ then ‘begin application process’. There is also a link to an FAQ.

 

Copies of all certifications: front and back of cards, front only of certificates

BLS, ACLS, and PALS: http://www.americanheart.org/presenter.jhtml?identifier=3012360

ATLS: http://web2.facs.org/atls/ATLSSearch.cfm?Search=USA. As of October 2008, the American College of Surgeons is certifying PAs like they do physicians.

NRP: http://aap.peppsite.com/dlsp/NRP/NRPHome.cfm?page=nrp&ad=1

APLS: http://www.aplsonline.com/find_apls_course.cfm Finding a course may be difficult, but I found it to be very useful for my practice. It’s an accepted alternative to PALS here.

FCCS: http://www.sccm.org/SCCM/FCCS+and+Training+Courses/FCCS/FCCS+-+Resources.htm#6. Scroll to the bottom to click on 2007 and 2008 course listings.

 

NCCPA wallet card and certificate: NCCPA states on their website, “Please note: Your NCCPA wallet card should not be submitted to any third party as proof of certification.” But one credentialing agency still wanted the card and not a letter nor certificate. You do not automatically get a wallet card; it has to be requested at the website – the link is on the left when you log in. After you log in, you can also click on “Credentialing Info Release” to have a letter sent on your behalf verifying proof of certification. I did this to get my license and first job faster – otherwise I’d have needed to wait for the certificate to arrive in the mail.

 

Diplomas: Copy of undergraduate diploma and PA diploma. For each school, have a mailing address, department phone number and fax number, plus a department contact person (with title and email).

 

NPI letter of approval: According to CMS (Center for Medicare Services), if you provide billable services that are billed to Medicare (and who doesn’t?), you need an NPI. Go to https://nppes.cms.hhs.gov/NPPES/StaticForward.do?forward=static.instructions for a list of information you need and a link to apply. This is free. When approved, you will get a letter by snail mail, email, or both. Copy this letter; it is your proof of NPI. NPI FAQ (not the most user-friendly, but manageably navigatable): http://questions.cms.hhs.gov/cgi-bin/cmshhs.cfg/php/enduser/std_alp.php?p_sid=Qjr3YRYh&p_lva=&p_li=&p_page=1&p_cv=&p_pv=&p_prods=0&p_cats=&p_hidden_prods=&prod_lvl1=0&p_search_text=NPI&p_new_search=1&p_search_type=answers.search_nl

 

UPIN: page printed from CMS website. If you graduated after June 29, 2007 you do not need a UPIN. In June of 2006 CMS decided to issue them to all midlevels; June of 2007 they discontinued them. I don’t want to know why…

 

State Medicare & Medicaid numbers: I still haven’t figured Arizona out yet… plus your state may vary… so you’re on your own here.

 

CME: NCCPA CME log printout, with copies of CME documentation. You can start logging your CME after earning your certificate (for PAs who took the PANCE in 2005 or later). You can view your record when you are done and print out a nice summary that has been universally accepted. However, one hospital did want paper copies of my last 20 hours of CME. The most CME requested was the last 2 years.

 

References: Four seemed like the magical number. As a new grad I listed my dean, instructors and preceptors. After a few months of work, I asked coworkers and attending if they would be references. Having a mix seems to be a good thing; all request people who have worked with you in the last 6 months to 2 years, but some want colleagues and some want physicians. All want mailing address, phone, fax and email.

 

Previous work history: Every contact person and their title, address, phone number, fax number for the last 15 years. Some wanted all work history, some only relevant to the current position. The number of years that was requested was 7, 10 or 15.

 

Everything I’ve done, listed month-by-month, for the last 15 years: Now that you’ve told them when you were in school and when you were working, you will need to explain any gaps between. Explanations were requested for either 30-day gaps or 90-day gaps. Even the gap between finishing PA school and starting the first job (waiting for PANCE results, getting licensing, getting credentialed) had to be explained. Some asked for supporting contacts… you know the routine – address, phone, fax, email. The more information you have at your fingertips, the better. Ask if family is okay – that’s who I used for some of mine.

 

Hospital affiliations: List of all hospital affiliations with addresses, phone numbers, fax numbers, dates. This is everywhere you have applied for credentials. They may want a hospital contact. “Medical Staff Services” and “Credentials Verification Office” are the common office names here for the people in charge of your hospital privileges.

 

Proof of insurance: Copy of all liability insurance policies, including during PA school. These seem to be good for one calendar year. Your program should have given you a copy prior to clinical (so I am told). And unless you buy your own policy, each employer will give you one too (you may have to request it).

 

Immunizations records: Copy of immunization record showing PPD status. Everyone here has asked; some want proof. Apparently, in Arizona all HCPs must have proof of recent TB status. It’s not listed in the PA codes, but elsewhere. Of course, this may vary… but if you have it, you might as well put it in your notebook.

 

And finally… a list of all expiration dates and deadlines:

State license - 1 year

DEA - 3 years

malpractice - 1 year

All certifications (BLS, ACLS, etc) 2 years each

NCCPA – good for 6 years

Deadline for filing CME log with NCCPA – June 30 of the second year after passing the PANCE, to avoid the late logging fee. December 31 to keep your certificate. And while I told you above that you can log your CME for free, it will cost $80 to process your CME log and enter the next 2-year cycle of your 6-year certification ($95 if you send in a paper log instead of doing it online).

PPD - 1 year

Last time notebook was updated

Last time CV was updated

When to next update 15-year history and time gap list

[kittryn]

very helpful post, LA, thanks for taking the time to summarize.

 

I'm really bad at logging CME -- it's good to see those parameters. I need to get on the stick with this! :eek:

[Esmerelda]

WOW!! Great post. Thanks for the info.

[danielle]

Thanks! I wish I wouldn've seen this a couple weeks ago.

[unewillow]

Having just gone through almost all of the above myself this is a great list.

 

I would like to add though, that along with a DEA number most states require you to file seperately for prescription privileges. So, another thing to look into for your individual state.

 

Also, for your immunization records many hospitals require you to have proof that you've had your Hep B series and either had Chicken Pox or got the vaccine for you younger peoples. If you haven't had titres drawn already for them I recommend getting them done and keeping a copy of the results.

 

Lastly, keep in mind that getting medical staff privileges takes at least a month at most hospitals, and that's the minimum if you're right out of school without a long employment history. The sooner you can get all of your documentation together and copies sent to the right places the faster you'll be able to start working.

[Guest lisnek]

iew, too much work lol.

 

nice in an "ideal" world.

[leahk]

thanks! very helpful... panic attack inducing...but very helpful!

[JenGintheED]

thanks! very helpful... panic attack inducing...but very helpful!

 

Don't panic... just work on it a little bit each day. It's much more manageable in small doses :p

[leahk]

when i tried to getm y dea # it seemed you need to have a place of employment listed... is it necessary to have a job lined up first?

[unewillow]

I wouldn't think so, since if you change jobs you take you number with you so it isn't location dependant. You could always call and ask I guess. Though you may want to wait until you have a position lined up since you may not even need to get a number, and if you do your employer might pay for it or reimburse you for the cost.

[ventana]

Just my $0.02

 

Get and keep a 3 ring binder with all the document protectors empty in it. EVERY time you get something important throw it in there - i have done this for the past 10+ years and it is amazing how well it keeps things organized through the years....

[mjl1717]

Clear me up on.... Social Security Card is important! But it is NOT considered an official form of I.D. True or False?

[kidnid]

WOHHHHHHHHH.......... I need to get hosp. credentials too at 3-4 hopspitals...... gosh!! this scares me....

[Guest SLP2PA]

"Also, for your immunization records many hospitals require you to have proof that you've had your Hep B series and either had Chicken Pox or got the vaccine for you younger peoples."

 

LA: since you're in AZ, too, what do you know about this for the hospitals around here for PAs? I'm currently a Speech Pathologist and work PRN at multiple hospitals in the west valley and they all offer a declination form for the Hep B to all HCP. Is it the same for PAs though? I'm still in the Pre-PA stage. If you know of any PAs I can shadow around the west valley I'd love to hear about it. Great post!

[caldje]

FYI,

 

I hate all this stupid frikin' paperwork.

 

sincerely,

chris

[JenGintheED]

SLP... contact forum member ajnelson. She's in the west valley. There are a few others here, too; you might try a post in the Arizina forum.

 

I don't think we are allowed to decline HBV because of the risk of transmitting it to a pt. I had to submit proof of vaccination with my credentialling packet.

 

Chris, if you're gonna be in the hospital, you might as well get used to it. Hospitals are now required to recredential providers every 2 years. It seemed a little easier the second time around. :)

[caldje]

 

Chris, if you're gonna be in the hospital, you might as well get used to it. Hospitals are now required to recredential providers every 2 years. It seemed a little easier the second time around. :)

 

I noticed that in our medical staff bylaws. I was hoping it was some sort of sick joke. ;)

[Guest SLP2PA]

Thanks, LA, but I checked under "state specific" on the PA forum under professional PA and Arizona is missing! Where's the AZ forum?

 

I'll have to look further into the Hep B thing and ask around. They allow nurses to decline Hep B, and they're in people's body fluids all day. And as an SLP working in acute care I also work with trach/vent patients, those with bloody secretions coming out of their trach, etc. and they still let me decline HBV. Hep B is not that easily transmittable from provider to patient, it's much more likely to be the other way around, and even then I've read only about 30% of those exposed actually acquire it. Do they force PAs to get the flu shot for fear of transmittal of infectious disease, too? Right now my hospitals offer it and I can just accept it if I want it or verbally decline.

 

Other question: I have an NPI now as a Speech Pathologist...do people from previous professions have to get new ones when they become PAs? I would think not, but just checking. Mine was really quick and easy to get online, no biggy.

 

So recredentialling for PAs is every 2 years in hospitals? So do you need to have 4 references checked again every 2 years as well? Do PAs have to do all the other "nicities" other allied health care providers have to do annually, though? For example now I'm doing all the annual HIPAA, OSHA, and so many annual things we have to do. Usually they are modules on the computer you have to complete each year. Usually all the hospitals have you do it once a year on your anniversery, however Maricopa Med. Center gives you continuous modules all year long, sometimes like 10-15 per month!

[ajnelson]

SLP... contact forum member ajnelson. She's in the west valley. There are a few others here, too; you might try a post in the Arizina forum.

 

I don't think we are allowed to decline HBV because of the risk of transmitting it to a pt. I had to submit proof of vaccination with my credentialling packet.

 

Chris, if you're gonna be in the hospital, you might as well get used to it. Hospitals are now required to recredential providers every 2 years. It seemed a little easier the second time around. :)

 

SLP -

I'm in the northwest valley if that helps you at all. I'm pretty sure we can have people shadow, but I know they don't allow PA students...I'll have to check into the details with my medical director so I know for sure though.

I'm not sure if we were able to decline vaccinations at all, I've had the HBV series twice, so I just submitted the paperwork, and I don't recall any vaccination declination paperwork, although they may have had it available if needed. The best people to answer the question (as it may vary hospital to hospital) is the medical staffing office. The staff in my hospital was fabulous through the whole process!

[JenGintheED]

Chris - can't remember who came up with the rule, but they are now required to check your status with the National Practitioner Database. I'd ask David Carpenter for details if you were curious... he's a wealth of info.

 

SLP... ask that question in your other thread. Some people following that thread would have more input and be more informed than I am.

 

Scott Young is in the area, I think. Try sending him a PM.

 

I get "annual compliance training" from my employer, but the rest of those things I don't do anymore. But I am an IC, not an employee of the hospital. Try a new thread for further info on that .

[Guest SLP2PA]

ajnelson, yes, I'm in the northwest area by Glendale and would love to get in touch with you.

 

Thanks, LA.

 

I liked that idea from an above post about creating a notebook to put all this information together. Woudn't it also be good to scan everything into the computer and put everything on a DVD? Then you could just print copies when ever you need them. :) I have all my SLP documents on a flash drive. Makes it so easy to just go and print stuff out as needed, and everything is nice and organized.

[coloradopa]

ajnelson, yes, I'm in the northwest area by Glendale and would love to get in touch with you.

 

Thanks, LA.

 

I liked that idea from an above post about creating a notebook to put all this information together. Woudn't it also be good to scan everything into the computer and put everything on a DVD? Then you could just print copies when ever you need them. :) I have all my SLP documents on a flash drive. Makes it so easy to just go and print stuff out as needed, and everything is nice and organized.

You pose an interesting NPI question. I can't find this covered in my material. I dropped a line to Michael Powe.

 

As far as recredentialling it gets easier after you have been in practice. Basically you give them 3-4 names of other PAs and physicians. The hospital sends out letters that they send back. The other stuff such as national provider check happens pretty much invisibly.

 

On the other hand the more experienced you get the more painful the initial credentialing process becomes.

 

One thing that was discussed at the APPAP roundtable was a logging program through either NCCPA or AAPA. This would allow you to log all your procedures and potentially patient encounters with them. It would be a portable item that you could take with you from place to place. The advantage for this would we also would be able to use this for research. For example if someone asked how many PAs do central line insertion we could tell them how many PAs and how many they do.

 

David Carpenter, PA-C

[JenGintheED]

As far as recredentialling it gets easier after you have been in practice. Basically you give them 3-4 names of other PAs and physicians. The hospital sends out letters that they send back. The other stuff such as national provider check happens pretty much invisibly.

 

Not that easy at my facility. I had to repeat the ENTIRE process... a 20-page credentialling application, all my certs, immunization records, copy of malpractice... PLUS a list of all EM-related CME, and a copy of my NPDB and other database report (had to get my own). Ugh... :(

[Guest SLP2PA]

David, that logging program sounds extremely interesting.

 

 

To all, I just came across this that I thought might also be helpful to some regarding the hospital credentialing process. http://www.aapa.org/gandp/pdf/pahpman.pdf

[coloradopa]

David, that logging program sounds extremely interesting.

 

 

To all, I just came across this that I thought might also be helpful to some regarding the hospital credentialing process. http://www.aapa.org/gandp/pdf/pahpman.pdf

Thanks. BTW here is the answer to your question about NPI numbers changing from SP to PA:

 

Typically, the person would not need a new NPI number. Medicare would require that the person go to the NPI application update form (www.cms.hhs.gov/cmsforms/downloads/CMS10114.pdf) and change their taxonomy code from speech path to PA for their existing NPI number. Section D of the NPI update form is dedicated to taxonomy numbers.

In section D there will be a click on option to see taxonomy numbers for various professions.

 

David Carpenter, PA-C