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HCA 267: Provider Credentialing 2

Course Description

This course will focus on the intermediate steps in the healthcare 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 healthcare law, terminology and cases. (3 credits)

Prerequisite

  • HCA 265: Provider Credentialing 1

Student Learning Outcomes (SLOs)

Students who successfully complete this course will be able to:

  1. Define the healthcare provider credentialing process and standards.
  2. Describe the credentialing standards through the regulatory and accrediting bodies.
  3. Apply clinical privileges according to the provider specialty.
  4. Describe staff management, operations and information management.
  5. Examine the implementation of medical staff bylaws.
  6. Outline healthcare law, legal cases, legal terminology and the Healthcare Quality Improvement Act (HCQIA).
  7. Explain departmental operations required by a CPCS MSP.

Course Activities and Grading

AssignmentsWeight

Discussions (Weeks 1-7)

15%

Assignments (Week 1-3)

20%

Midterm Project (Week 4)

20%

Final Essay (Week 7)

30%

Final Exam (Week 8)

15%

Total

100%

Required Textbook

Available through Charter Oak State College's Book Bundle

  • Russell. (2022). Verify & Comply: Credentialing, Medical Staff, and Ambulatory Care Standards. 10th ed. HCPro, Inc. 

Additional Required Textbook

Not available through Charter Oak State College's book bundle or 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 as you should have purchased it for Provider Credentialing 1.

Course Schedule

WeekSLOsReadings and ExercisesAssignments

1

1-3

Topics: Healthcare Provider Credentialing II Defined, CPCS Exam Information

  • Readings:
    • Russell, Introduction, Chapter 1,4,7
    • NAMMSS, pp. 6-10 & 145-148, Exam Prep Summary, CCN Scale Score Information
  • Read assigned chapters
  • Review assigned materials
  • Participate in Discussions
  • Submit the Week 1 - 2022 Provider Credentialing Corrections Environment Summary
  • Submit the Week 1 - Credentialing Requirements of a Nurse Practitioner

2

1-5

Topics: Accrediting Standards and Regulatory Guidelines

  • Readings:
    • Russell, pp. 35-39, 203-227, 361-379
    • NAMSS, pp. 31-64
  • Read assigned chapters
  • Review assigned materials
  • Participate in Discussions
  • Submit the Week 2 - What is Credentialing; an overview for NP’s
  • Submit the Week 2 - Privileging Form Activity
  • Begin work on the Week 4 - Midterm Project

3

1-5

Topic: Clinical Privileges and Provider Specialty

  • Readings:
    • Russell, Chapter 9
    • NAMSS, pp. 8-16
  • Read assigned chapters
  • Review assigned materials
  • Participate in Discussions
  • Submit the Week 3 - Summary Reporting Adverse Clinical Privilege Actions
  • Submit the Week 3 - Medical Staff Bylaws
  • Continue to work on the Week 4 - Midterm Project

4

3,4,5

Topic: Midterm Project

  • Participate in Discussions
  • Submit the Week 4 – Midterm Project
  • Submit the Week 4 – Summary of Credentialing PowerPoint

5

2,7

Topic: Credentialing Specialist Operations

  • Readings:
    • Rusell, Chapter 9
    • NAMSS, pp.113-144
  • Read assigned chapters
  • Review assigned materials
  • Participate in Discussions
  • Submit the Week 5 - Required Medical Staff Committees
  • Submit the Week 5 - Roberts Rules of Order 
  • Begin work on the Week 7 - Final Essay

6

5,6

Topics: Law and Legal Cases

  • Readings:
    • Russell, Chapters 2, 3, 5, 6, 8, 10
    • NAMSS, pp. 3, 71, 104, 143
  • Read assigned chapters
  • Review assigned materials
  • Participate in Discussions
  • Submit the Week 6 - Key Credentialing Cases
  • Submit the Week 6 - Ongoing Monitoring
  • Continue to work on the Week 7 - Final Essay

7

3,6,7

Topic: Final Essay

  • Readings:
    • Russell, Chapters 2, 3, 5, 6, 8-10
    • NAMSS, pp. 113-144
  • Read assigned chapters
  • Review assigned materials
  • Participate in Discussions
  • Submit the Week 7 - NAMSS MSP
  • Submit the Week 7 - Final Essay

8

5

Topic: Final Exam

  • Review:
    • Russell, Chapters 1-10
    • NAMSS, pp. 3, 6-64, 71, 104,113-144
  • 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.