Biographical sketch, kathy matzka, cpmsm, cpcs

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Board Certification

The ABMS coordinates the activities of its 24 Member Boards in the United States and provides information to the public, government, medical profession and its Members concerning issues involving specialization and certification in medicine. According to the ABMS, the fundamental objective of its member boards is to act in the public interest by contributing to the improvement of medical care by establishing qualifications for candidates and by evaluating those who apply for certification.
The 24 ABMS member boards offer general and sub-specialty certificates. Each specialty board acts as an independent body determining its own requirements and policies for certification. The board accepts candidates for certification from persons who fulfill its requirements, administers certification exams, and issues certificates to those who pass. All member boards require a written exam and most also require an oral exam. Obstetrics and gynecology, neurological surgery orthopedic surgery, pathology, physical medicine & rehab, radiology, and urology boards have an additional requirement for one to two years of clinical experience.
At one time, boards issued lifetime certificates meaning once you were certified, you were certified for life. All ABMS member boards now have time-limited certificates and require recertification. Most boards now require recertification after 10 years with the exception of Family Practice (7 years), OB/GYN (7 years), and Pediatrics (7 years). If you query an ABMS member board and ask about “board eligibility”, it will respond by stating an individual's precise position in the certifying process.
The American Osteopathic Association does continue use the term “board eligible”. AOA Board eligibility status terminates on December 31 of the sixth year after completing the training program. AOA has 18 certifying boards.
Hospital requirements for board certification vary, often based on physician availability. Those hospitals located in a geographic area with an abundance of physicians often require board certification, while those in underserved areas often do not. It is not unusual for each medical staff department to set its own criteria for privileges which may include board certification. Some managed care organizations require board certification to participate in provider panels.
If certification is required, it is necessary to keep track of all certifications and expiration dates. Bylaws should define any requirements for board certification/eligibility and a process should be in place to verify board certification. If the medical staff requires board certification on appointment or within a certain timeframe, follow-up should occur to assure these requirements are met. Reminder letters should be sent to physicians prior to the expiration of their boards or eligibility. Include in this letter the bylaws language that requires board certification. Whatever your requirements, make sure that they are consistently applied.
Board certification is usually verified by obtaining confirmation from the board. Board certification for ABMS boards can be verified via the ABMS CertiFacts online, the ABMS Certifax service, ABMS products administered through Choice Point Services, Inc. and the online subscription service, AOA certification can be verified via the AOA Official Osteopathic Physician Profile Report or AOA Physician Master File.
The American Board of Medical Specialties (ABMS) has replaced its recertification program with a Maintenance of Certification (MOC) program that reflects the concept of physician practice assessment based on performance rather than solely on success on a written exam. This includes assessment of six “general competencies” - patient care, interpersonal and communication skills, professionalism, medical knowledge, practice-based learning and improvement, and systems-based practice. The MOC has four basic components requiring evidence of professional training, lifelong learning with involvement in a periodic self-assessment process, cognitive expertise, and evaluation of performance in practice.
What About Those “Other Boards”
There are many self-designated medical boards in the U.S. that are not members of the ABMS or the AOA. While hospitals and medical staffs set their own criteria for appointment, careful consideration should be given to specifying which certifying boards are considered acceptable.

Medicare CoPs Regarding Board Certification

§482.12(a)(7) [The governing body must] Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship or membership in a specialty body or society.
“A hospital is not prohibited from requiring board certification when considering a MD/DO for medical staff membership. Rather, the regulation provides that a hospital may not rely solely on the fact that a MD/DO is or is not board certified in making a judgment on medical staff membership. In addition to matters of board certification, a hospital must also consider other criteria such as training, character, competence and judgment. After analysis of all of the criteria, if all criteria are met except for board certification, the hospital has the discretion to decide not to select that individual to the medical staff.” (Source: CMS Interpretive Guidelines)

Verification Of Identity

Joint Commission standards require the organization to verify the identity of the practitioner requesting by viewing a current picture hospital ID card or a valid picture ID issued by a state or federal agency (e.g., driver's license or passport). It is expected that this be done prior to the practitioner providing patient care, treatment, or services.

Sample Policy and Procedure for Verification of Identity

It is the policy of ___________ Hospital to verify the identity of all licensed independent practitioners (LIPs) who apply for medical staff appointment and privileges prior to the practitioner providing any patient care, treatment, or services. This is done to determine that these practitioners are the same practitioners identified in the credentialing documents.
Verification of identity can be accomplished by viewing any of the following:
Military ID, State ID, Customs Passport, State Drivers License
Verification can be done during any of the following processes:

  • During provider orientation

  • During the process of obtaining hospital picture ID

  • Any time the practitioner presents in person to the Medical Staff Office

After presentation of a valid Military ID, state drivers license/ID, or customs passport that includes a picture, the person verifying completes the Verification of Identity Documentation Form (Attachment A). The completed form is forwarded to the Medical Staff Office for inclusion in the practitioner’s credentials file.

Reference: Joint Commission Hospital Standard MS.06.01.03
Attachment A

Verification of Identity Documentation Form
Practitioner Name: ____________________________________________________
I have reviewed the following identification for the above-named practitioner:
 Military ID

 State Driver’s license or ID ______________________________________

[list issuing state]
_______________________________ ____________________

Signature of person verifying Date


Printed name of person verifying

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