Board Certification

Question 1

The Joint Commission
Board Certification

Answer 1

Not specifically required, but if the organization requires certification or recertification, verification should be performed. Verification may be obtained directly from the specialty board. ABMS and its certified display agents are considered an equivalent primary source.
The American Osteopathic Association (AOA) Physician Database can be used for verification of Osteopathic specialty board certification

Question 2

NCQA
Board Certification

Answer 2

CR3
1. Element A Factor 3 & 4 if a practitioner claims to be board certified, the organization must verify it. Verification of board certification meets the requirement for verification of education and residency training.
2. Verification for physicians may be obtained through an of the following:
a. ABMS, its member boards, and its approved display agents
b. AOA official osteopathic physician profile report
c. AOA/AMA physician master file
d. confirmation from specialty board
e. confirmation from the State licensing agency if there is a confirmation that this agency conducts primary verification of board status
3. Must document the expiration date of the board certification in the credentialing file. It it is a ‘lifetime’ certification status with no expiration date, verify that the certification is current and document date of the verification
Note: verification of board certification is not applicable to nurse practitioners or other health care professionals unless the organization communicates board certification to members
Other HCP
1.Verification must come from the appropriate specialty board, state licensing agency or registry if there is documentation that primary source verification of education and training is performed.
2. The organization may use confirmation from the State licensing agency or registry if it verifies that the source performs PSV, and, at least annually, the organization must obtain written confirmation from the approved source that if performs PSV
Note: the ABMS website provides a public source called “is My Doctor Board Certified” which is not an acceptable form of credentials verification
CR3 Element A Factor for Time limit, must be verified within 180 days (MCO)/120 days (CVO) of the credentialing decision

Question 3

ACHC
Board Certification

Answer 3

1. The medical staff may not make its recommendation solely based on the presence or absence of board certification.
2. A hospital is not prohibited from requiring Board Certification, but this cannot be the only criteria used when considering a physician for medical staff membership.
3. A hospital must also consider the request for clinical privileges, current licensure, training and professional education and supporting references of competence
4. Board certification must be reviewed for each applicant/reapplicant during the review and approval process,
   a. Verify with ABMS if physician is certified by a member of board ABMS,
   b. if certified by AOA specialty board, verify with AOA official osteopathic physician profile.

Question 4

DNV
Board Certification

Answer 4

MS.3 SR.3
1. A Medical staff may not rely solely on board certification when making a decision on privileges
2. All credentials are examined
3. MS.6 SR.4a & 5a Any organization required certifications must be primary source verified initially and at reappointment

Question 5

URAC
Board Certification

Answer 5

1. View board certification, if applicable. This is required for initial credentialing only, unless the board certification no record of the verification in the practitioner’s record
2. If a physician has multiple board certifications, than at a minimum, verify for the specialty under which the practitioner be listed in the directory.
3. Sources can include the AMA master file, AOA master file, or specialty board or registry.
4. URAC recognizes those sources that the ABMS has designated as primary equivalents as ones that are primary as well.
5. Any organization can rely on the verification activities of the state licensing boards. If this is done, it should be noted in the credentials file. Confirmation that the state board does verify a credential before relying the the board
6. Time limit: must be verified within 180 days of credentialing decision

Question 6

AAAHC
Board Certification

Answer 6

Verify from primary or secondary source

Question 7

Medicare Hospital COPS
Board Certification