Name that professional:
  1. There’s a shortage of them, yet their salaries don’t reflect the fact that demand outweighs supply.
  2. They don’t directly interact with patients but are considered gatekeepers to patient safety with stringent duties set by state and federal laws, third-party regulations/standards, organizational bylaws, and organizational and/or departmental P&Ps.
  3. They handle coordination and verification of nearly all data on a provider before that clinician can start generating revenue, but they aren’t viewed as being tied to the revenue cycle.
  4. They’re backed by a well organized, progressive national certifying body that advocates for them vigorously. Yet despite repeated requests from that body, the U.S. Office of Management and Budget and its Standard Occupational Classification Policy Committee won’t classify them as a unique profession in the Standard Classification Occupation Manual. Instead, the Office lumps this career it in with HR and administrative management professions.

It’s medical staff services and medical credentialing, of course (and the national certifying body is NAMSS). There are great expectations for the future of MSPs: salary-wise, in terms of their potential contribution to healthcare reform, with regard to how they can help foster ways for credentialing/enrollment to be more than a cost center in an organization.

Let’s focus on number 4:

What effect does or will it have on the profession that the U.S. Government department responsible for classifying all occupations in which work is performed for pay or profit refuses to recognize medical staff services as a unique occupation. Does it matter?

The profession continues its great work by focusing on the proficiencies equipping MSPs for the challenges ahead. The U.S. Office of Management and Budget and its Standard Occupational Classification Policy Committee will catch up at some point.

NAMSS is at the forefront of advocating for MSPs and medical credentialing professionals and publishes forward-thinking competencies for advancement and recognition. These are the professional skills that will propel MSPs and credentialers in the long term.

NAMSS

Eight core functions of the MSP have emerged, according to NAMSS.

In a 2016, a State of the Medical Services Profession study was conducted by NAMSS, in which MSPs from across the country were asked to evaluate 42 tasks and responsibilities to determine which best represent the duties, functions, and tasks they handle at all levels and years of experience. Of the 42 tasks and responsibilities, eight core functions of the MSP emerged:

1. Conduct, participate in, and maintain credentialing and/or privileging. Example: Compile, evaluate, and present the practitioner-specific data collected for review by one or more decision-making bodies.

2. Conduct, participate in, and maintain primary source verification. Example: Recognize, investigate, and validate discrepancies and adverse information obtained from the application, primary source verifications, or other sources.

3. Conduct, participate in, and maintain current clinical competency evaluations and peer review. Example: Coordinate an appropriate evaluation by physician leaders of gathered data.

4. Manage compliance with accreditation and regulatory requirements. Examples: A) Facilitate efficient and cost-effective due process that complies with an organization’s fair hearing and appeals policy as well as applicable legal and regulatory requirements. B) Develop and implement a tracking system to ensure that credentialing is completed within defined regulatory timeframes.

5. Manage departmental operations. Example: Audit, assess, procure, implement, effectively utilize and maintain practitioner/provider credentialing processes and information systems (e.g., files, reports, minutes, and databases) by analyzing the needs and resources of medical services/credentialing.

6. Manage the credentialing and/or privileging process. Example: Evaluate credentialing/privileging requests including evidence of education, training, and experience to determine eligibility for requested privileges, membership, and/or plan participation.

7. Comply with accreditation and regulatory standards, policies and procedures. Example: Participate in an ongoing assessment of governing documents (bylaws and rules and regulations) to ensure continuous compliance.

8. Manage medical staff functions. Example: Develop and coordinate on-boarding processes (orientation and training activities) to assist practitioners/providers and to meet education requirements.

On top of NAMSS’ core proficiencies, there’s a skill set chart by tenure (e.g., 0-4 Years, 5-14 Years, etc.) to check out.

Other Resources

Healthcare consulting firm The Greeley Company also publishes MSP competencies using the Six General Competencies framework established for physicians by the ACGME and ABMS.

According to the firm, “In the world of clinically integrated healthcare, the traditional role of the MSP to administer a risk-adverse, quality-focused, and practitioner-friendly credentialing process is strained by mounting financial and market pressures. This scenario of a perfect storm provides MSPs with opportunities to redefine their skills…” Their MSP General Competencies are offered in a white paper.

Do you know of any other comprehensive resources that list and publish MSP competencies? We’d love to hear from you…