HCA 265: Provider Credentialing 1

Course Description

This course will focus on the basic steps in the provider credentialing process and the responsibilities of a provider credentialing specialist. The purpose and use of medical staff bylaws will also be covered along with an introduction to the peer review process. (3 credits)

Prerequisites

  • None

Student Learning Outcomes (SLOs)

Students who successfully complete this course will be able to:

  1. Discuss the provider credentialing process and standards.
  2. Describe the credentialing application, review, and approval process.
  3. Apply legal and ethical considerations to the provider credentialing process.
  4. Describe the functions of ongoing monitoring in a provider credentialing department.
  5. Explain the purpose and use of medical staff bylaws.
  6. Outline the peer review process.

Course Activities and Grading

AssignmentsWeight

Discussions (Weeks 1-8)

20%

Midterm Project (Week 4)

10%

Quiz (Week 3 & Week 5)

10%

Assignments (Weeks 1-7)

40%

Final Exam (Week 8)

20%

Total

100%

Required Textbooks

Available through Charter Oak's online bookstore

  • Russell. Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards. 10th ed. HCPro, Inc., 2022. ISBN-13: 9781645351986

Additional Required Textbook

Not available through bookstore

  • NAMSS. Certified Provider Credentialing Specialist Study Guide. NAMSS.
    • This is an electronic copy that is not available through the Charter Oak bookstore. It must be purchased directly through NAMSS and price will depend on NAMSS membership vs. non-membership. This will be used in both Provider Credentialing courses so there will be no textbook cost for Provider Credentialing 2.

Course Schedule

WeekSLOsReadings and ExercisesAssignments

1

1

Topic: Provider Credentialing Introduction

  • Readings:
    • Read pages 1-6 in the CPCS Study Guide
    • Read Verify & Comply 10th Edition pages 5-7, 147, 177-178, 241-242, 307, 337-339
  • Read assigned chapters
  • Review assigned links
  • Introduce yourself in discussion forum
  • Participate in Discussions
  • Submit Week 1 Assignment - Article Review

2

2,5

Topic: Application & Standards

  • Readings:
    • Read pages 7-22 in the CPCS Study Guide.
  • Read assigned chapters
  • Review assigned links
  • Participate in Discussions
  • Submit Week 2 Assignment – Medical Staff Policy
  • Begin working on Midterm Project

3

1,2

Topic: Staff Categories and Staff Status

  • Readings:
    • Read pages 23-67 in the CPCS Study Guide.
    • Read Verify & Comply 10th Edition pages 35-36.
  • Read assigned chapters
  • Review assigned links
  • Participate in Discussions
  • Submit Week 3 Quiz - Medical Staff Categories & Roles
  • Submit Week 3 Assignment - Red Flags
  • Continue working on Midterm Project

4

4

Topics: Ongoing Monitoring

  • Readings:
    • Read pages 68-110 in the CPCS Study Guide.
    • Read Verify & Comply 10th Edition pages 29, 53, 67-69, 101, 109-111, 139-141,199-200.
  • Read assigned chapters
  • Review assigned links
  • Participate in Discussions
  • Submit Midterm Project

5

2,6

Topic: Ongoing Monitoring (Continued)

  • Readings:
    • Medical Office Management, Chapter 13
    • PowerPoint presentation
  • Read assigned chapters
  • Review assigned links
  • Participate in Discussions
  • Submit Week 5 Quiz - Ongoing Monitoring
  • Submit Week 5 Assignment - Article and Agency Review

6

1.6

Topic: Peer Review Process

  • Readings:
    • Read pages 74-118 in the CPCS Study Guide.
    • Review Verify & Comply 10th Edition pages 29, 97, 101, 125, 199, 261, 265, 275-277.
  • Read assigned chapters
  • Review assigned links
  • Participate in Discussions
  • Submit Week 6 Assignment - Peer Review Outline

7

3,6

Topic: Peer Review Recommendation

  • Readings:
    • Review prior readings from Week 6
  • Read assigned chapters
  • Review assigned links
  • Participate in Discussions
  • Submit Week 7 Assignment - Peer Review Recommendation Form Template

8

5

Topic: Medical Staff Bylaws & Final Exam

  • Readings:
    • Medical Office Management, Chapter 17
    • PowerPoint presentation
  • Review assigned links
  • Participate in Discussions
  • Complete Final Exam
  • Complete Course Evaluation

COSC Accessibility Statement

Charter Oak State College encourages students with disabilities, including non-visible disabilities such as chronic diseases, learning disabilities, head injury, attention deficit/hyperactive disorder, or psychiatric disabilities, to discuss appropriate accommodations with the Office of Accessibility Services at OAS@charteroak.edu.

COSC Policies, Course Policies, Academic Support Services and Resources

Students are responsible for knowing all Charter Oak State College (COSC) institutional policies, course-specific policies, procedures, and available academic support services and resources. Please see COSC Policies for COSC institutional policies, and see also specific policies related to this course. See COSC Resources for information regarding available academic support services and resources.