Accreditation Newsletter

HAPPY NEW YEAR!

Welcome to the premiere issue of the Professional Services Network's Accreditation Newsletter. Our mission is to help organizations prepare for URAC or NCQA accreditation, which can be a daunting task.

The term "accreditation" is tossed around quite a bit in the healthcare industry, but what does it mean exactly? Merriam-Webster Online says
it "give[s] official authorization to or approval of" your organization. It shows that your group meets nationally recognized, measurable standards of quality and excellence. Accreditation can set you apart from your competitors, and in today's marketplace, that's a MUST.

In each issue of the Accreditation Newsletter, we will cover topics such as URAC and NCQA policies and procedures and industry happenings. Plus, we will give you helpful hints on how to handle stumbling blocks that could slow down your accreditation or re-accreditation process.

Please feel free to give us feedback. We'd love to hear from you!

–	Peggy Thomas, RN, MS Senior Consultant, Accreditation Services pthomas@psninc.net Phone: 877-753-1776

CONSULTANT SPOTLIGHT (back) (next)

Meet one of our highly qualified consultants.

Cynthia E. Whitaker, RN, BSN, CCM

Cynthia has successfully assisted organizations in case management and disease management program development and preparation for URAC accreditation. She has spoken at regional and national healthcare educational seminars and workshops, including those at conferences, such as the Case Management Society of America, Case Management Society of Australia, Association of Rehabilitation Nurses, American Board of Utilization Review Physicians, American Back Society, and Northwestern National Life Insurance Company's Rose Conference. She has published articles in the Case Manager, Continuing Care, and "The Case Report" in the Journal of Care Management.

Cynthia was a founder and president of the Northern California chapter of Case Management Society of America, and later served as National Secretary and President of CMSA. She was a committee member and an author for CMSA's Standards of Practice for Case Management, and Vice Chair of the Case Management Advisory Committee, which designed the Case Management Organization Standards for URAC Accreditation.

URAC ACCREDITATION TIP(back) (next)

Question:

Regarding URAC's regulatory compliance standard (Core 21), what are some reference sources for keeping up-to-date with applicable State and Federal regulatory requirements in the jurisdictions where an organization conducts business?

Answer:

It is necessary to contact the state regulatory boards of each state where the organization conducts business to assess and comply with healthcare licensure requirements. Many states have enacted regulatory requirements for organizations conducting programs in Utilization Management (90% of all states), Case Management, Health Call Center, Credentialing, Health Plan, Health Network and Independent Review. (URAC has two recent publications that outline federal and state regulations for Utilization Management and Case Management).

Corporate personnel assigned with the task of assuring corporate regulatory compliance may rely on newsletters, email postings, and regular communications provided by America's Health Insurance Plans, URAC, relevant trade association groups, such as the Case Management Society of America, Healthcare Information and Management Information Systems Society, and other public policy groups, or those groups that monitor laws and regulations, enacted and/or proposed.

Monitoring HIPAA regulations is also necessary for most organizations to demonstrate continuous compliance with Federal regulations that must be maintained and verified, at least electronically, for on-going updates of the regulation.

INDUSTRY NEWS (back)

Thoughts for Re-Accreditation

URAC expects companies that are seeking re-accreditation to show a "history" of URAC compliance, not just a few weeks or months. Companies that are granted a conditional accreditation by URAC should be able to show at least six months' history of corrections that have been implemented to receive full accreditation.

To achieve this goal, ongoing auditing of Case Management or Utilization Review files is a must. Professional Services Network has highly experienced consultants who can help.

Be sure to PLAN AHEAD. You should start your re-accreditation initiative at least one year prior to URAC's site visit. This will give our consultants and your staff adequate time to ensure accreditation success.

Please give us a call with any questions you may have.

Do you have an accreditation-related question that you would like us to address in a future issue?

Would you like additional information about our services?

Send us an email – or call us at 1-877-753-1776.