New pact makes it easier to credential physicians
Plans may use AMAP data to meet standards
The credentialing process for physicians became easier this year when the American Medical Association (AMA) and the National Committee for Quality Assurance (NCQA) agreed that data from the American Medical Accreditation Program (AMAP) can be used by managed care companies to meet NCQA standards.
The agreement has the potential of saving a tremendous amount of time for physicians and their staffs. The agreement is designed to promote efficiency and reduce duplication in the credentialing of physicians by health plans. A joint statement by the two organizations predicts that the agreement will save money for physicians, health plans, and employers.
AMAP is a national accreditation program for physicians created by the AMA. Physicians who apply for accreditation are evaluated against national standards and peer performance in credentials, personal qualifications, and the environment of care. Clinical performance and patient outcomes standards will be added in the future.
Managed care organizations and AMAP
The NCQA has agreed that managed care organizations can rely on data obtained through the AMAP program as being in full compliance with the relevant NCQA standards. In addition, the health plan can use an AMAP accreditation survey report in lieu of an office site visit.
This means that if your office has achieved AMAP accreditation, you may be able to avoid going through the credentialing process for each of the health plans with which you contract when they are seeking NCQA accreditation.
Because the average physician’s office contracts with 10 managed care plans and has to fill out 10 similar credentialing forms and go through 10 different site visits every few years, the agreement has the potential of saving a lot of staff time.
The joint efforts of the two organizations should reduce duplication, save money, and allow health care resources to be used to improve care for patients, says Randolph Smoak Jr., MD, president-elect of the AMA and chair of the AMAP governing body.
"This type of cooperation among private-sector accrediting bodies was a major goal when we developed the AMAP," Smoak says.
AMAP also has agreed to contract only with NCQA-certified credentials verification organizations. The NCQA will establish a Credential Ver ification Organization Standards Advisory Committee that will include two physician representatives from the AMA/AMAP. The committee will recommend standards and scoring to be used by the NCQA to certify the credentials verification organizations.
In addition to accrediting managed care organizations, the NCQA certifies credentials verification organizations.
Through the Performance Measurement Coord ination Council, the two organizations are working with the Joint Commission on Accreditation of Healthcare Organizations to coordinate use of performance measures at the organization, plan, and physician level.
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