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Credentialing and Peer Review

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Hospitals, health plans and physician organizations are increasingly being subjected to litigation proceedings over the manner in which they implement their credentialing policies and procedures, and administer their peer review committees and hearings. Long gone are the days when privileges were granted by accommodating colleagues and conducting cursory reviews. Today, organizations can face liability for not appropriately evaluating a practitioner's history, or for inappropriately terminating a physician's right to remain on staff or to serve as an approved provider.

Medical staff bylaws, rules and regulations must provide the framework for self-governance, and allow practitioners to conduct their affairs in a manner that provides quality health care. Burnham Brown attorneys regularly advise clients regarding the preparation of medical staff bylaws, on the duties and responsibilities of officers and committee members, and on their procedures for automatic and summary suspensions and other corrective action matters. Some of the issues addressed by our credentialing and peer review practice have included the following:

  • Developed physician organizations bylaws, rules and regulations, and counseled clients on the adoption and administration of these governing structures.
  • Provided legal opinions regarding the approval and disapproval of amendments to medical staff bylaws, rules and regulations. Ensure their compliance with state and federal laws and accreditation entities.
  • Represented physician organizations in legal proceedings regarding the termination of physician privileges.
  • Provide advice and counsel regarding physician organizations response to Medical Board investigations.
  • Developed complete peer review guidelines for Independent Practice Assocations.

Hospitals, health plans and physician organizations are increasingly being subjected to litigation proceedings over the manner in which they implement their credentialing policies and procedures, and administer their peer review committees and hearings. Long gone are the days when privileges were granted by accommodating colleagues and conducting cursory reviews. Today, organizations can face liability for not appropriately evaluating a practitioner's history, or for inappropriately terminating a physician's right to remain on staff or to serve as an approved provider.

Medical staff bylaws, rules and regulations must provide the framework for self-governance, and allow practitioners to conduct their affairs in a manner that provides quality health care. Burnham Brown attorneys regularly advise clients regarding the preparation of medical staff bylaws, on the duties and responsibilities of officers and committee members, and on their procedures for automatic and summary suspensions and other corrective action matters. Some of the issues addressed by our credentialing and peer review practice have included the following:

  • Developed physician organizations bylaws, rules and regulations, and counseled clients on the adoption and administration of these governing structures.
  • Provided legal opinions regarding the approval and disapproval of amendments to medical staff bylaws, rules and regulations. Ensure their compliance with state and federal laws and accreditation entities.
  • Represented physician organizations in legal proceedings regarding the termination of physician privileges.
  • Provide advice and counsel regarding physician organizations response to Medical Board investigations.
  • Developed complete peer review guidelines for Independent Practice Assocations.