Spillin' Tea Across America: Montana

[00:00:00] Hey, Nyleen! Hey, Shannon! Oh, girl. You know, when people hear Montana, they think mountains, ranches, even Yellowstone, honey. And I guess while they're dramatically staring over a valley, I mean, that's how I would do it, right? Absolutely. I want to go to Montana. I haven't been. I hear it's beautiful. You know, when we left in the RV, we left, but it was wintertime, so we really couldn't.

[00:00:25] And Montana, even Yellowstone was closed. So I feel bad I didn't get to see that, you know? But anyway, I hear Montana and I asked, I guess we asked, who is credentialing the person at the tiny rural hospital, maybe three hours from anybody, right? Well, yeah, that's a good question because that's MSPs are hard to find, especially because the view can be gorgeous. And of course, the compliance file can still be a hot mess.

[00:00:52] And sometimes this stuff happens in small little hospitals. Montana gave us actually a little bit of everything, Shannon, though, because we have good policies. That was good policies. Yes. Big federal money, new provider mobility and some oversight stories that made me say, wait, who had the receipt? And why did it take this long? You ain't lying, honey. And I guess that's going to be our question today, right? Or today.

[00:01:21] Are things good? Are things bad? I mean, maybe they are both really when we looked at it, right? Montana is trying to expand access to people while also carrying some very, very heavy accountability baggage. And one story involves the hospital even losing doctor's privileges, thousands of pages reportedly going to a licensing board, repeated license renewals. And then, of course, years later, then a permanent revocation. So there's a lot of tea here.

[00:01:49] OK, did you all hear Nyleen? Did you all hear her? OK, that is not one missed checkbox, right? That is an information flow problem. So let's spill the tea. Yeah, oh yeah. Well, Nyleen and Shannon sitting there talking about you while you pull up a chair.

[00:02:10] OK, welcome back to Credentialing Chronicles, where we spill the tea across America right now and connect every headline back to the system that was supposed to protect the patient. I'm Nyleen. And I'm Shannon. Follow Credentialing Chronicles on LinkedIn, Instagram, Facebook, TikTok, I mean YouTube, everywhere you all. And make sure you send this episode to someone who still thinks that a clean license lookup is the whole credentialing process.

[00:02:35] Well, quick disclaimer, the episode, this episode does discuss lawsuits, investigations, regulatory findings, disciplinary proceedings and news reporting. Allegations are allegations unless and until established through a final legal or administrative process. We are relying on publicly available records and reporting available as of September 8th to 2026.

[00:02:58] This is commentary and education, not legal or clinical advice or MSP advice for credentialing. Follow your policies and procedures, your regulatory bodies, your bylaws, all the things. OK, guys, and we have not credentialed or been involved in any of these cases. Yes, this is all advice. And because laws, waivers and agency guidance change, verify the current primary source before making an operational decision, you all.

[00:03:24] Now, let's start with the part Montana can generally, genuinely celebrate. Well, let's talk about Medicaid because Medicaid is so different in every state and there's so much rules. And it's so hard because Lord knows every time we move from state to state or get a client in another state, we got to spend, you know, three weeks trying to learn and figure out Medicaid.

[00:03:47] But in 2025, Montana actually removed the sunset that threatened its Medicaid expansion that preserved coverage for more than seventy six thousand people. And in a rural state, that's really not a side story. Medicaid can really be the difference between a clinic getting paid and then a clinic disappearing. Yes, we are seeing that, to be honest, all over Oklahoma, you know, with the big, beautiful bill that was passed. It's just it's crazy.

[00:04:13] So I'm very happy that Montana was able to keep coverage for all of those people. That part is very good. Full stop. To be honest, people keep coverage. Providers retain a payer source and rural communities keep more stability. But then July 1st, 2026 arrived. Well, Montana became one of the first states to implement the new federal community engagement requirement for expansion on adults.

[00:04:40] Generally affected adults between like 19 and 64 have to complete about 80 hours of like qualifying activities like work, school, volunteering, training, you know, an apprenticeship or essentially just qualify for an exclusion. And existing members do not all flip on one day. Right. The requirement reaches them at redetermination.

[00:05:04] So Montana also announced a July through September hold harmless period, meaning noncompliance would not cause denial during that window if the person met the eligibility rules. Oh, well, that sounds orderly when you say it so slowly. But in real life, the reality is right. We change jobs. A school record maybe doesn't match an exclusion is encoded. Right.

[00:05:28] A notice goes to some old address and suddenly the patient at the front desk thinks that the provider is the one who dropped them. But that's not really the case. And, you know, 19, sometimes life just be life and you don't even have time to check the mail. Right. And then the credentialing enrollment team say we are active with Medicaid. The billing team says the claim was denied. And the patient says, I thought I had coverage last month. Those are three different truths in one hallway all living at this girl. That's my life every day.

[00:05:58] Every day. I am literally fighting. Yes, I'm literally fighting between Medicare and signal right now on a patient. Anyway, Montana says the rules are about regular eligibility checks on personal responsibility. So I do want to take a quick second just to do a quick PSA.

[00:06:15] If you see Medicaid patients in any state, the recommendation is always you run eligibility on the day of service because that will assist you with appealing a denial. So if you run eligibility that morning or at the time the patient checks in, that verification can be attached to your appeal. So you print it out and you attach it to the file just in case. Right. Yep.

[00:06:43] So critics worry that, of course, the administrative burden will just disenroll eligible people. So they're just going to like one big message, massive update. But yet both can be true. A policy can have a stated accountability goal and still create the procedural losses. Eileen, you're talking some real compliance lessons here, honey. I mean, because eligibility is not enrollment and enrollment is not active network status.

[00:07:10] And network status, you all, is not a clean payable claim. So you have to build escalation paths between registration, enrollment, billing and patient financial services before that denial arrives at your door. Exactly. And this is why we need to get our own college degree for all of this payer enrollment stuff. Or intense apprenticeship. Right. Exactly. Well, and that's why we have to document what staff tells patients.

[00:07:38] If the rules are changing, yesterday's script can become today's misinformation. And as I say, real time information at the time of service can be the difference between paid and not paid. Exactly. And everyone listening, follow us on all platforms because these are the operational details that never fit into the headline and that you're only really hearing from Credentialing Chronicles. So this episode is totally supported by Bataan Health.

[00:08:06] Credentialing teams do not need more time signing, more waiting, more uncertainty. Bataun helps organization modernize primary source verification and truly build faster, more reliable workflows around provided data. Because when the source changes, the files should not be the last place to find out. So learn more about Bataun Health through the link in our show notes, BataunHealth.com. Now, for the money.

[00:08:36] Montana received about $233.5 million for federal fiscal year 2020 through the Rural Health Transformation Program. One of the largest awards for the state in any of the states of the United. I don't know why I said it that way. That was weird.

[00:08:57] The state's priorities really include like workforce, facility, sustainability, new care models, community based access and of course technology modernizations because that's one of the most expensive things. Right. In a rural health community. They can't always afford the new fancy robot. They can't always afford the new software system. Right. So it sounds exactly like what rural Montana needs. And not only Montana, I'd say this Rural Transformation Act.

[00:09:26] I know we have to apply for this assistance and you have to provide a lot of documentation because my hospital is currently doing that as well. But it is a very good program and it has potentially right. Potentially the funds haven't necessarily been dispersed just yet, but it gives the opportunity to really help a rural state like this. And credentialing chronicles loves investment, but money you all does not transform a system by itself. Money does not solve all the problems.

[00:09:56] Money without governance becomes a beautiful PowerPoint followed by a very uncomfortable audit as we've all seen. Yes. And you know, girl, I'm a little worried because, you know, you get all this money. I wonder what's going to happen with COVID where, yes, this money became available and then, you know, the wrong doctors or the wrong providers or the wrong administrators or the wrong CEO. And I think that's a lot of people who are going to misappropriate these funds.

[00:10:20] So it's definitely something that we need to keep track of in our world and to see kind of what happens in the next five years. But anyway, this is where my little compliance alarm keeps ringing because federal awards mean milestones, allowability, right? Procurement records, performance measures, and then proof that you said and you use the money for what you said you were going to use the money. And you know, I went through that, honey, with the PPOC, but I'm also- Yes, me too. Yes.

[00:10:49] Yeah, me too. Okay. And provider workforce money creates credentialing pressure every day. So if you recruit clinicians faster and do not strengthen verification, privileging, enrollment, and monitoring capacity, you build a shiny front door and a traffic jam behind it. Oh, yes, girl. Imagine a rural state finally like recruits a specialist. It has the need for like 18 months, right? Everyone is happy.

[00:11:17] And then yet nobody goes ahead and confirms payer moment. Nobody starts the process. You have a telehealth dilemma, maybe. You know, you have this reassignment that I'm dealing with right now, right? With rural health clinics, you have a whole nother set of rules for this. Maybe you didn't check malpractice history or DEA or onboarding. So you didn't do the privilege requests, right? So the specialist shows up and then you can't even bill for them or can't perform the service that everybody thought that they could do.

[00:11:44] And you are paying high dollar for that very hard to find specialist right now. Absolutely. Absolutely. Probably some relocation. Can't be cheap to want to move to Montana. Yeah, the relocation. And then you're not making any money on the back end and leadership announces a start date before the application is complete. So then credentialing becomes the villain in the story for saying that the provider is not ready. No, baby. We did not create time.

[00:12:13] We did not create this problem. It's crazy. And I mean, did y'all hear that? I mean, if transformation funding is paying for access and credentialing readiness is actually a program deliverable, not an administrative afterthought. You know, we can be cautiously optimistic, but you have to wait till you go through the credentialing process. Yeah, true. And our score, very good opportunity, very good execution risk.

[00:12:39] Montana has to really show that dollars become durable access, right? Not just contract software in temporary positions. Right. That's a big burden, right? It is. It is. And they're going to have to prove it all if the money gets awarded, right? Right, right. And so, well, it's promised, right? They just have to actually deliver it. Mm-hmm. So that means it's not in your bank account yet, y'all. I'm, we're still waiting for ours. So I know that, you know. Anyway, so let's talk about some other cool stuff.

[00:13:08] So Montana, we're giving you some props and we know you had some, some bad stuff in certain parts, Helena, but we're not going to go there. I don't remember. I don't remember. We're giving you some props to Montana here. So let's talk about PAs, right? Physician associates, so physician assistants, whatever you want to call them. I mean, I know physician associates now. Okay.

[00:13:28] So Montana also joined the physician assistant licensure compact in 2025 through the House Bill 183 becoming the 15th, 15th state to enact it, which is really, really cool. The goal is mobility to obviously make it easier for eligible PAs to go ahead and practice across member states, including supporting rural and telehealth access, which is extremely important in rural health communities. Yeah. And that is a great policy for a state with huge distances and workforce shortages.

[00:13:58] But for credentialing teams, listen carefully. A compact privilege is not the same thing as a medical staff privilege or a payer enrollment or an employment clearance or even a completed delegated credentialing file. Correct. Say it again, Shannon. It's not the same thing, guys. There's all definitions.

[00:14:15] So a mobility pathway changes how authority to practice may be obtained, but it does not erase the organization's duty to go ahead and verify all the things that have to be verified, which is identity, education, training, sanctions, malpractice history, current competency, and whatever else applies according to your bylaws, rules and regs and all of that. And to be honest, Montana already allows experienced physicians assistants a more independent practice pathway under earlier legislation. This is not new.

[00:14:45] So your forms and workflows must reflect the actual state rules you all. If your application still assumes that every PA has the same supervision structure, your process may be outdated before the provider even signs. And that's what I love about credentialing because we have to learn every year, right? Every year, every month, every time the new laws come out, we have to be the ones to study it to make sure that our policies align with our practice. The practical move is the compact checklist, right?

[00:15:14] Home state license, compact eligibility, privilege status, expiration and renewal triggers, scope, practice site requirements, pay your rules, and then obviously continuous monitoring, but making sure that we're updating everything so that it matches and aligns. Definitely. Nyleen, you couldn't have said it better. And one thing I would add, do not let compact become co-word for we verify less. Mobility should reduce duplication, but it should not reduce diligence.

[00:15:41] And that's why it's so important that you should verify. I mean, guys, best practice. I understand the minimum requirement is to verify this license in the state in which they are practicing. But I promise you best practice is to verify it and everywhere that they are at. Okay, guys. My PSA number two. Oh my goodness. I'm doing my PSAs in between. You're doing it today. Yes. This episode is supported by Nimble.

[00:16:04] Complex healthcare operations need workflows that help teams see what is missing, what is moving and what needs attention without living inside a spreadsheet maze. If your team is ready to make provider operations more nimble, please. Yes, we said it. Visit the link in our show notes. Nyleen, what's that link? NimbleRCM.com. Now we have to talk about Montana State Hospital, you guys. It's literally the state psychiatric hospital in Warm Springs.

[00:16:34] Y'all, Trucy, CMS terminated its Medicare provider agreement in April of 2022. After finding some serious failures involving patient safety and the conditions of participation. Oh my goodness. You know, we're always talking about CMS in our hospital. I know how important it is. It's never big until they come audit. Absolutely.

[00:16:58] Public reporting connected the crisis to girl, patient deaths, inadequate staffing, infection control failures, and other like dangerous conditions. The loss of certification meant the hospital could not bill Medicare or Medicaid for patient services costing millions and millions of dollars. Because remember, that means that if you can't bill for Medicare or Medicaid, you can't bill for any of those replacement plans either. Exactly.

[00:17:24] And by December 2025, the state finally submitted a request for recertification. So it took them about three years to clean it up. In January 2026, officials said CMS would need to perform an unannounced survey, which we all know and are very rare. And that additional corrective action steps might still be required. So they're letting them know. Wow. Four years from decertification to a recertification request.

[00:17:50] That is the part I cannot just go past because a plan of correction is not the same as a sustained correction. Like, wow, that's a long time. Yes, exactly. And Nyleen, everyone can get ready for it. Everybody can get ready for a survey, right? But the real test is like Tuesday night on a short staffed unit when nobody thinks an auditor is coming, right? Of course, of course. Girl, I've been audited on New Year's Eve. Like, really? Come on.

[00:18:19] The auditor says she was not going out that night. She was coming to the hospital. Seriously. I love it. There was even a public discussion about seeking federal standing without a full electronic health record. Like, officials correctly noted that an EHR is not itself a formal condition for certification. But they also acknowledged that better infrastructure could support compliance, which is why I love the digital process. But again, technology is not compliance, right? Correct.

[00:18:46] But weak technology can make compliance very, very fragile, y'all. And hard to deal with. If medical records, treatment plans, incident follow-ups, staffing evidence, and company records cannot be retrieved and trusted, the organization is operating on hope alone. And, you know, we always talk about this and we have brought this up in other episodes, but mental health patients are especially vulnerable. You know, I learned when I was like, you know how people reach out to you on LinkedIn and stuff.

[00:19:14] They had talked to me a little bit about behavioral health. And honestly, guys, I've never worked in behavioral health. So all I know is like book stuff. I don't know like real practical stuff. But mental health regulations for charting is very different than your regular inpatient stay at like a hospital. And they're going to have fewer advocates, less ability to leave and more dependency on the institution. And notice that, you know, deterioration, the burden on the staff is going to be more.

[00:19:42] And that makes all the documentation, the staffing and accountability more and definitely not less important. True. And Montana really deserves credit for investing in reform and seeking recertification. But the honest score is still red until independent surveyors confirm sustained compliance. Do not grade patient safety on effort. Never, never. Good point. Okay, girl. So I got another story.

[00:20:09] Now the story credentialing people are going to discuss, girl, after this episode is this doctor who was a oncologist. Whose medical staff membership and clinical privileges were revoked in 2020 after peer review concerns.

[00:20:25] A 2025 Montana Superior Court decision described concerns that included manipulation of do not resuscitate status, substandard care and inappropriate chemotherapy treatments. Those are descriptions in the literal court record, not our independent clinical findings.

[00:20:45] Well, ProPublica and Montana Free Press reported that the hospital provided the state medical board thousands of pages of material beginning as far back as 2021. But the board kept renewing his license. So this is going to be an update to our released episode. We did have an episode on this, but we do have more updates. So the hospital revoked privileges.

[00:21:12] The board reportedly had thousands of pages and the license stayed active for multiple renewal cycles. This is why I keep saying that license verification is the floor, not the ceiling. We always say this. Well, what happened was board members told reporters that they had been not been aware of the material, which is crazy because if I send you thousands of pages, what do they do like get burned or something? Where did the thousands of pages go? Right.

[00:21:37] So later in 2025, board investigators found violations of professional rules and standards of care involving at least seven former patients. Now we know that there's more that were affected. But anyway, in December, an adjudication panel unanimously accepted the findings and then finally, finally, finally permanently prohibited him from practicing medicine in Montana. So just that's an update, because when we first released our episode, he was still had an active license.

[00:22:07] So since then, the board has acted and now he cannot practice anymore in the state of Montana. And it only took us a year to get here because we talked about him in season one. And now we're season two spilling the tea in Montana. And they finally took his board license. Yay. Good day in credentialing. That final board action matters though, you guys. It also does not erase the years in between. Right. The question is not only did the board actually act.

[00:22:36] It is what did the intake, the triage, the investigation, the renewal, the escalation process do with the information when it literally arrived. Right. And the hospital privilege action did not automatically equal a license action. Different bodies having different standards of authority and evidence, but the separation is exactly why reporting channels and follow ups matter. One hundred percent. If a hospital reports an adverse action, who confirms receipt? That's the question. Who tracks it?

[00:23:05] Who checks whether the state board, the NPDB, the payer and other facilities have the information they are legally, literally entitled to receive? Who makes sure such a giant document does not become a digital graveyard? No, you're absolutely right. And guys, if you do not, I'm sorry, I'm going into this PSA segments like all the time.

[00:23:29] But listen, one of the things I learned as an early MSP from my mentor is every month on your reporting report to credentials to MEC is to follow those NPDB reports. Right. So that maybe if your hospital didn't have any issues and they had issues somewhere else or if their DEA gets revoked or if somebody expressed concerns, some any kind of report that you have documentation that your hospital did review the findings.

[00:23:55] So anyway, this reminds me of files where somebody says it was uploaded. And then the question is uploaded where reviewed by home assigned to what risk level escalated on what date closed based on what decision and upload is not an action. And my other little two seconds of PSA is save the emails on your doctor.

[00:24:19] Yes. And I can't express this the most out of anything because nothing matters until it matters. So, yes, be tedious. Save the email. But anyway, CYA, CYA. OK, oh, my God. Yes. And if the only proof is a clean license screen, the file can look beautiful while the risk is literally screaming from another source. Right.

[00:24:43] Exactly. And then for fairness, now, this doctor did dispute allegations and did end up litigating against the hospital for them doing what they did. But the final Montana board action in twenty twenty five of December is the clearest administrative end point. Permanent loss of the ability to practice medicine in the state. Yeah. And I think hospitals a lot of times don't want to go to battle with the doctors. And so a lot of them will just kind of move it, move it along, move it along.

[00:25:08] And this is really an example, a beautiful example of a doctor of a hospital organization saying we are going to protect our patients from this provider. And it doesn't matter if the provider wants to battle us because the state board said that he was being dangerous and really, truly backed up the hospital. I mean, this story is the Montana team, but the lesson is national and for hospitals everywhere.

[00:25:32] Fragmented oversight creates windows where each organization can say that part belongs to somebody else. Patient safety, you all lives in all of these windows. Mm hmm. And this is why, guys, we need you guys to follow credentialing chronicles and tell us, like, does your organization, you know, text us, direct message us. We are just two normal people, right? So y'all know how to find it.

[00:25:56] Does the organization track hospital adverse actions before or beyond that one time application question? Because if the answer is no, this story is really like your audit prompt. Yeah, I mean, truly, truly, truly. So Shannon, are things good or bad? Is Medicaid expansion good? I think so. The new eligibility paperwork, high risk for coverage disruption, rural health money. Great opportunity. Great opportunity. Execution and grant compliance.

[00:26:25] Definitely something that they have to watch closely in the state of Montana. Oh, yeah, you ain't lying. And then, like you said, PA mobility, good for access, but only if organizations are updating their workflows. Montana state hospital reform may be moving, but federal recertification and sustained compliance are the real proof here. Medical board accountability.

[00:26:45] The final revocation, sorry, was decisive, but the delay exposed a dangerous information problem. All right. So let's do like five takeaways, right? I'm going to do one. Number one, verify beyond the license. I know you said that all episode, right? Privilege history. Check your privileges. Make sure that they're good. An NPDB, information where authorized. Have your NPDB updates.

[00:27:14] We know NPDB is going continuous query. Thank goodness. So everybody's going to be on continuous query. If there is an alert on continuous query, make sure you're bringing it to your committee. Malpractice, sanctions, references, competency, and any adverse action disclosures are not decorative. They are necessary when processing and reviewing an application. Well, and if I can add to that, if you have something that Nylene is talking about, privileges,

[00:27:39] NPDB, all of those things, you must go to the provider and get an updated disclosure of questions with an explanation. Because that's what the board is going to ask for. Right. And adding to that, the doctors, if you have an action, just disclose it. It's just much easier if you just tell them. Go to your MSP. Not that big deal. Okay. Everybody's got something on the record. We're not all perfect. Life be life and we get it. Okay. Okay. Number two, track every red flag to disposition.

[00:28:07] Receipt, the owner, the risk level, investigation, escalation, decision, and even the closure, you all. Put it in an Excel and just start tracking. If you cannot reconstruct that chain, you do not have defensible evidence that you were part of it or that it actually closed the loop. Girl, CYA, didn't we just say that? CYA, always save everything. Keep track of everything. Okay.

[00:28:31] So number three is compact practice authority does not replace organizational credentialing, privileging, or payer enrollment in any kind of way. So I and I suggest, we suggest, we suggest, I think credentialing chronicles suggest verify every license in every state that they have, not just the state that they're practicing in. In their DEA. Because like, like, like Nylene said, DEA alignment. If people are moving, you need to make sure that DEA is aligned. Number four, access policy creates back end work.

[00:29:01] So Medicaid eligibility changes you all and rule recruitment dollars must be matched by enrollment, billing, training, communication, and then monitoring capacity. Well, and number five, a corrective action plan is a promise. But if we have sustained performance, that is your proof. I like that one. I like that one. I mean, so that is this whole episode right now. Montana is simply not good or even simply not bad.

[00:29:29] It is investing in access while learning sometimes painfully that access without accountability can harm patients. So before we do our final close out, let's just make this useful. If somebody is listening in Montana, girl, we've done a lot of PSAs this episode and y'all can implement whatever you think in your policy and your practice. We're just telling you what's worked for us. So in any rural market, what are we going to go ahead and audit Monday morning, Shannon? I like that. Well, first adverse action intake, right?

[00:29:57] Pull your policy and ask where information can enter the application, the attestation and PPP query. All of these things that Nylee has been talking about, even peer references, peer notices, state board alerts, malpractice carrier, employer. I mean, even the news, you all to get the Google alert. Then ask whether every entrance leads to one control review process. Because if the medical staff office has one inbox, compliance has another legal has another.

[00:30:26] They have their own folders and provider enrollment then is somewhere in the little corner. The organization doesn't have one risk picture. It has four partial pictures. And guys, I'm going to tell you this happens every day just because let me give you an example. We credentialed the provider. I come to find out the CNO says, oh, by the way, in our contract, he's going to assign his benefits. So now I'm scrambling trying to do payer enrollment. The communication barrier is real.

[00:30:54] The idea of what nobody needs to know is real. We need to improve that in all of our centers. That is not a Montana problem. That is a, you know, frustration for all provider enrollment specialists. Yeah, because I mean, really, that's where it's all falling apart. Right. I mean, leader leadership says one thing and they don't even realize the time and everything that it takes. I mean, yeah, that they're losing. Right.

[00:31:21] And even the providers, I mean, you know, right now we have some VHS going into one of our new clients that we got and we're just trying to get Medicare established. And, you know, we text, call, email the providers outside of working hours because we're like, look, just work with us. We work with you. Let's get everybody billable. This one provider, honey, she wants to talk about I only want to be contacted from nine to five. I only want to be contacted on my email. I'm like, you just really don't care that this organization needs to be able to bill for yourself.

[00:31:50] She's talking about I got six patients to see. I'm like, baby, you've got six patients to see that they're not being paid for. How about that? How about that? But OK, you take your time, mama. You take your time. So anyway, then sample 10 cases, not just the dramatic ones. You guys can you see the date received? Who reviewed it? What policy standard was literally applied and what additional records were requested with this? Who made that decision? And then whether follow up monitoring was truly imposed. I mean, that is your right.

[00:32:19] And if the answer is everybody knows so and so handles it. Right. That's not a control thing. Right. It's just like a prayer requests because maybe Susie Q doesn't do it. You know, you know, I love the Lord, but God did not tell us to skip the audit trail. He did not. Well, and then the whole license renewal logic, right? A renewed license is one data point.

[00:32:40] Your file should ask whether there has been a restriction, an investigation, a privilege action and employment separation, a criminal matter, malpractice development or new competency concern. And just remember, guys, all of your bylaws will say if there is a change in anything. So if your DEA got revoked or you voluntarily surrendered, your license changed, if you got named in a lawsuit, like all of these changes are supposed to be reported to your medical staff in an X number of days. Right. There is a policy.

[00:33:08] I have hospitals that some are 10, some are 30, some are 15. So check your bylaws, see what the requirements are and hold the physicians accountable to that. Mine is like 72 hours. Like I need it within 72 hours because we got to report it to everybody. And do not write a question so narrow that a provider can technically answer.

[00:33:27] No, you guys, while the real issue walks literally right past you, match the language to your bylaws policies, pay your contract, use that language, accreditation standards and truly the applicable laws in your state. And then train reviewers on what requires escalation. Mm hmm. And then compact readiness, build a separate source map for every compact profession that you use. What is verified with the home state? What comes from the compact commission?

[00:33:54] What do we still have to get from primary source school board certification? Right. Database. Right. There's all these things that we have to get. Yeah. And this is where organizations get seduced by speed. Right. Leadership hears, you know, interstate mobility and thinks, oh, that means they're ready the same day. No, Papa credentialing hears it and should think differently. They should think a different authority, a different source and a different literal explanation. Right.

[00:34:23] I mean, well, I can literally hear somebody saying, oh, but the provider is licensed. Right. OK. But are they privileged for this procedure? I enrolled. I literally stand on a soapbox. I have an entire presentation about privileging enrolled under the right service location. Right. Are we affiliated with the right billing entity? Were reassignments said to the right tax ID number or the right P-10? Are you loaded correctly into the directory? Right. Ready is a collection of yeses, not just one.

[00:34:52] Yeah. I mean, even taxonomy right now, honey, people are not playing with taxonomy. Don't. And providers never even cared about it. And people that aren't thorough didn't care about it. But now it's the number one thing people are using to deny people. So did y'all hear Nyleen? A collection of yeses. We need it. One green light does not turn the whole dashboard green with your beautiful credentialing software. It doesn't. Tell them. I know that's right. Well, and then Medicaid, right?

[00:35:22] So Montana moves provider portal users to a single sign on platform in April. And that might sound like an it note, but portal transitions really create operational risks. Wrong email addresses, right? You changed home. You changed locations. You have to get a new login. You lose your access, miss correspondence and applications sitting where just nobody can see them. Yeah. Any time a payer changes portal, Nyleen, you know, I want an access inventory. Who is the administrator?

[00:35:52] Who is the backup? Which email owns the account? We have to. And can staff see every provider and location? I mean, that's one of the first things that we do when we sign a client. We are going into ability. We're going into Optima. And we're looking like, is everybody there? I mean, it does take more time. It is auditing, but you literally where our notice is being routed. You have to know. And what happens when the one person with access leaves or the process is transitioned? Exactly.

[00:36:20] And then fifth, let's just talk about grant funded workforce onboarding, new materials, new stuff for every role supported by this rural transformation money. Connect the grant file to the operational file and like what actually happened, right? We're going to want to audit what we do and how we're using this money because that way program leadership proves the promise of the outcome that it was intended for. Yeah. I mean, you're not lying.

[00:36:50] And somebody needs to reconcile these records. If the grant says three clinicians were deployed by June, but one never completed enrollment and another one never received the required privileges, the narrative is not three clinicians deployed. You guys, the evidence has to tell the truth. And that evidence is showing one clinician was deployed. Right. So state hospital thinking for every facility. Don't wait for a catastrophic survey. Trend your incidents, your grievances have a peer review committee.

[00:37:21] Right. And don't delay on any corrective actions that you may find. Yeah, because departments will explain each event separately, but quality has to ask, whether those events form one pattern, a near miss in nursing, a documentation gap in medical staff, and a staffing exception in HR may be literally the same risk wearing three different outfits. And they might all be cute, honey. Oh man, that is a line of the episode, girl.

[00:37:49] The same risk wearing three outfits. Oh my God. And finally test the speak up culture. If a reviewer sees something that does not make sense, can they stop the file? Can a front desk employee escalate a patient safety concern? And can a nurse challenge a credential or privilege mismatch without being told to stay in her lane? Can that happen? Right. Because compliance fails quietly before it fails publicly, right?

[00:38:17] The person closest to the discrepancy often notices it first. Your system has to make it safe and required for that person to speak. Yeah, like how you said that compliance fails quietly over and over and over again until it's in the public, right? I mean, that's what we see a lot. So our Montana audit is not about attacking Montana. We love y'all. It is all about learning from Montana, preserve access, welcome qualified providers, and use the funding like even Nyleen is doing in her hospital.

[00:38:47] And truly, truly build control strong enough to deserve the public's trust. That's all this is about. And if you are a patient, that's why you're listening to this episode, because you want to know the behind the scenes. What are these hospitals doing? And we're letting you know. I know. So, guys, if this episode made you rethink a file, a one escalation process, one audit trail, one renewal decision, go ahead and share it with your team. Yes. Follow Credentialing Chronicles on every platform. Leave us a review.

[00:39:16] Send us the healthcare tea from your state. You can DM us quietly. But we want the receipts, the policy and the credentialing lesson, not just the gossip all the time. Right. Because every license, behind every license, application and committee decision is a patient assuming somebody checked. And we are going to keep asking whether they did every day. So stay credentialed. And not canceled. Bye. Ooh, Shannon, that was a lot of tea.

[00:39:47] Honey, but have they subscribed yet to hear it next week? On all of these platforms. Please subscribe, like and follow us. Bye.