Biographical sketch, kathy matzka, cpmsm, cpcs



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Licensure


A license is the authority a government agency grants an individual to practice a profession. Regulation of medical and other professional practice is a state function. States exercise the regulation of medical practice through licensing laws. Some states issue a controlled substance license in addition to the license to practice medicine. If so, this license should also be verified.
State licensing boards also take disciplinary action against professional licenses. This may include revocation, suspension, probation or reprimand. Although basic information is available via the Internet or telephone, many state licensing boards will not provide specific information on disciplinary actions unless requested in writing. The extent of the information provided differs depending on the laws of the state.
It is essential to verify licensure status for all licensed providers in the state the practitioner will be practicing. It is up to the individual facility or MCO whether or not to check licensure in each state the applicant is or was ever licensed. Some states use reciprocity, which refers to agreements between jurisdictions in which states are willing to recognize each other's licensees based on comparable requirements for licensure. In many cases, not only do they accept the licensure of that state, they also accept disciplinary action from the other state.
Definitions of Licensure/Certification/Registration

Some professions are not licensed, but rather are regulated through registration or certification. Although individual states may have their own definitions, below are general definitions:


Licensure: The most restrictive form of professional and occupational regulation. Under licensure laws, it is illegal for a person to practice a profession without first meeting state or provincial standards.
Certification: Under certification, the state grants title protection (right-to-title) to persons meeting predetermined standards. Those without certification may perform the duties of the occupation, but may not use the title.
Registration: The least restrictive form of regulation. Usually takes the form of requiring individuals to file their names, addresses and qualifications with a government agency before practicing the occupation. This may include posting a bond or filing a fee.
Medicare CoPs Requirements for Verification of Licensure
The hospital must assure that personnel are licensed or meet other applicable standards that are required by State or local laws. All staff required by the State to be licensed must possess a current license. The hospital must assure that these personnel are in compliance with the State’s licensure laws. The laws requiring licensure vary from state to state. Examples of healthcare professionals that a state may require to be licensed could include: nurses, MD/DOs, physician assistants, dieticians, x-ray technologists, dentists, physical therapists, occupational therapists, respiratory therapists, and hospital administrators.

Sample Policies and Procedures for Credentialing

Verification of Current Licensure and Licensure Sanctions


POLICY AND PROCEDURES

[Facility Name]
Policy:
It is the policy of the Facility and Medical Staff to require verification of all relevant information provided on applications for Medical Staff appointment and/or clinical privileges. The verification of current licensure informs the facility that the applicant is appropriately licensed to practice as a health care provider as required by state and/or federal law. Practitioners currently licensed in the state of [add state name] are eligible to request Medical Staff Appointment and clinical privileges. AHPs holding a license, certificate or other official credential as provided under state law, are eligible to provide specified services in the Facility as delineated by the Medical Staff Executive Committee and Governing Body. In addition, Applications must include information as to previously successful or currently pending challenges to, or the voluntary relinquishment of a license to practice any profession in any jurisdiction.
It is the policy of the facility to verify current licensure in the state in which the facility provides services with the state licensure board or that board’s designated agent at the time of appointment and initial granting of privileges, at reappointment, renewal, or revision of clinical privileges, and at the time of expiration by a letter or computer printout obtained from the appropriate licensing board, through the primary source internet site, or by telephone.
It is the policy of this Facility to verify whether or not the applicant has been subject to licensure sanctions in each state in which the practitioner currently or has ever held a license or certificate. This is accomplished by either (1) querying the medical board of each state in which the provider has held or currently holds licensure, or (2) querying the Federation of State Medical Boards (FSMB).
Note: Each facility should customize the paragraph above to reflect current practices.
Note: If the Facility contracts with a Credentials Verification Organization (CVO), these licensure and sanction verifications may be provided by the CVO.

Procedure
Procedure for verification of current licensure and licensure disciplinary actions via internet site:


  1. Access the state licensure board web page for each state in which the license is held or has been held in the past. Each licensure board maintains a data base that can be used to verify licensure. Some states include all licensed and certified providers in one database, and some maintain separate data bases for nursing and other non-physician providers.


Note: The website of the Administrators in Medicine (AIM) Association of State Medical Board Executive Directors has a page with links to each licensure board’s web site. You can access this site at http://www.docboard.org/docfinder.html. The data in the AIM DocFinder database is intended for public use, not for commercial verification, and it requires a contractual agreement for the facility to use the database for verification of licensure. There are some state licensure boards that use AIM as their only source of internet verification and when you attempt verify licensure at the State’s website, it opens a link to AIM DocFinder. In this case, the AIM website is considered a primary source for the licensure board data for that state and you do not have to pay for this verification.


  1. Using the search mechanism on the state licensure board’s website, enter the required provider information and search. If you are searching on name only, the search results may contain more than one name. Examine each resulting name to determine the correct provider. In some cases, the search results may only provide a summary and you may have to click on an additional link(s) to bring up detailed information. Print all available information.




  1. If the results of the verification show that there was disciplinary action taken against the license, but this information is not available on the website, write to the licensing board and request the additional information. You can find the address on the licensing board’s website. Include a copy of the Applicant’s consent and release form with the request. Place a copy of the letter in the applicant’s credentials file.


Note: A listing of names and mailing addresses for all state licensure boards is also available at http://www.docboard.org/aim/brd_exec_dir.htm.


  1. Check the printed document(s) to make sure the current date is printed. If the verification does not have the date on it, write the date on the verification using permanent ink.




  1. Place the verification in the credentials file.




  1. Include the verification date in the [software name] credentialing software database.


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