About to blow a gasket: case logs

[Reality Check 2]

But I slept at a Holiday Inn Express.........................

Wonder if anyone credentials Naturopaths? 

[TexasPA28]

On 1/7/2019 at 9:23 PM, jmj11 said:

I really think there should be class action lawsuit against insurance companies over "credentialing." They claim that it is a tool for them to guarantee that the providers taking care of their subscribers are qualified. However, it is the responsibility of each state's  medical board to make sure that the provider is qualified. The insurance companies use it as delay technique that saves them millions in payments. Seriously, I'm not just blowing a gasket, but we need a lawyer who could do that. I sense damage to providers and hospitals is in the billions.

I agree with you but the hospitals hands are tied...

About 50 years ago scumbag lawyers convinced courts that business owners (ie hospitals) are always responsible for bad acts or negligence by their employees.  That's a nice trick because it means that the deeper pockets will have to pay up.

As a result of catastrophic lawsuit losses over rogue employees, the credentialing process has evolved into the Faustian octopus that it is now.

[ResusMachine]

I also learned this the hard way. Always ALWAYS  keep records of your procedures. 

After leaving my first hospital I was told I would need records for the last 12+ months to prove adequate volume for the procedures I was requesting privileges for. When I went back and asked for the records I was told it would take 1-2 months to run a query. Luckily, the next hospital agreed that a SP could attest to me having performed x number of each procedure and my being competent. 
The next hospital?  The IT department didn't return my calls (called for over a month). Billing dept said they bill under physician's name (impossible since no physician was present for the vast majority of procedures I performed). Had I not kept a little black book with a patient label and the procedure performed next to it, I'm pretty sure I'd be jobless right now.

[Cideous]

2 hours ago, ResusMachine said:

I also learned this the hard way. Always ALWAYS  keep records of your procedures. 

After leaving my first hospital I was told I would need records for the last 12+ months to prove adequate volume for the procedures I was requesting privileges for. When I went back and asked for the records I was told it would take 1-2 months to run a query. Luckily, the next hospital agreed that a SP could attest to me having performed x number of each procedure and my being competent. 
The next hospital?  The IT department didn't return my calls (called for over a month). Billing dept said they bill under physician's name (impossible since no physician was present for the vast majority of procedures I performed). Had I not kept a little black book with a patient label and the procedure performed next to it, I'm pretty sure I'd be jobless right now.

Un-freaking-beliveable

 

[cinntsp]

8 hours ago, ResusMachine said:

I also learned this the hard way. Always ALWAYS  keep records of your procedures. 

After leaving my first hospital I was told I would need records for the last 12+ months to prove adequate volume for the procedures I was requesting privileges for. When I went back and asked for the records I was told it would take 1-2 months to run a query. Luckily, the next hospital agreed that a SP could attest to me having performed x number of each procedure and my being competent. 
The next hospital?  The IT department didn't return my calls (called for over a month). Billing dept said they bill under physician's name (impossible since no physician was present for the vast majority of procedures I performed). Had I not kept a little black book with a patient label and the procedure performed next to it, I'm pretty sure I'd be jobless right now.

I've also had this issue when working on credentialing at a new hospital, but I don't do any procedures, which is even more ridiculous.  I just tell them that I won't be able to get them because the medical records database searches based on the admitting physician, i.e. even if I admit it'll be under a doc's name.  

[rev ronin]

22 hours ago, ResusMachine said:

Had I not kept a little black book with a patient label and the procedure performed next to it, I'm pretty sure I'd be jobless right now.

Pretty sure that's a HIPAA violation, as it serves no legitimate treatment or billing purpose for that patient.  Not that it's not a good idea, mind you, but many good ideas are, in fact, illegal.

[Cideous]

2 hours ago, rev ronin said:

Pretty sure that's a HIPAA violation, as it serves no legitimate treatment or billing purpose for that patient.  Not that it's not a good idea, mind you, but many good ideas are, in fact, illegal.

That is exactly what I was thinking.  HIPAA gone bad written all over that idea.

[cinntsp]

8 hours ago, rev ronin said:

Pretty sure that's a HIPAA violation, as it serves no legitimate treatment or billing purpose for that patient.  Not that it's not a good idea, mind you, but many good ideas are, in fact, illegal.

I don't think it is an issue as long as it's generally kept in a safe environment within the hospital/facility, i.e. personal locker or office.  If wanting to be very sure, something like a procedure logging app that encrypts the files would work.  

Edited November 3, 2019 by cinntsp

[rev ronin]

2 minutes ago, cinntsp said:

I don't think it is an issue as long as it's generally kept in a safe environment within the hospital/facility, i.e. personal locker or office.

... And on what do you base this?  What if it gets stolen or lost?  That will have personally identifiable medical information, tying specific individuals to specific treatments, and will have to be treated as a data breach.  I mean, I've used my HCISPP certification for almost precisely nothing since earning it 2014, but I'm pretty sure I'm not being overly paranoid here.

[cinntsp]

On 11/2/2019 at 8:37 PM, rev ronin said:

... And on what do you base this?  What if it gets stolen or lost?  That will have personally identifiable medical information, tying specific individuals to specific treatments, and will have to be treated as a data breach.  I mean, I've used my HCISPP certification for almost precisely nothing since earning it 2014, but I'm pretty sure I'm not being overly paranoid here.

What if a patient chart, EKG, radiology result, or whatever else gets stolen or lost from a secure place?

[rev ronin]

13 minutes ago, cinntsp said:

What if a patient chart, EKG, radiology result, or whatever else gets stolen or lost from a secure place?

That's a breach, and the affected patient (one, seemingly, in the case as posed) has to be notified.

 

[Mayamom]

Yup.  I just did a HIPPA retraining and this scenario came up.  Even if it's misplaced lost stolen inside the facility it's a violation.  Who knew!