Hospital credentialing, also referred to as healthcare or medical credentialing, is the crucial process for checking the background data and CV credentials of healthcare providers. This process helps to hire or choose the best healthcare provider to ensure patient safety.
Many cases of ill practice have been reported, affecting patients’ care and trust in healthcare organizations. Many reforms were introduced to cope with this situation, and medical credentialing is one of them. The whole scrutiny of healthcare providers’ education and expertise is done to improve healthcare standards.
In this blog, we will delve deep into the details of hospital credentialing steps, their importance, and the obstacles in undergoing this process. We will also discuss the impact of this on healthcare departments.
Hospital Credentialing Vs Hospital Privileges
Credentialing and privileging are slightly different, you can read our blog here to know the difference, but they are used interchangeably in healthcare. It is essential to know the differences. Medical credentialing is how to check or verify the candidates’ educational, experience, and training status. It helps to find out whether a healthcare provider is competent enough to treat the patients or not. If candidates get approved by the credentialing committee, they are presented with a medical practicing license to work in a specific healthcare department.
Hospital privileges are defined as the permissions given to healthcare providers, such as physicians’ scope of practice. What kind of care physicians can give to the patients comes under the privileges category. Privileges are of different types:
- Admitting Privileges
- Courtesy Privileges
- Surgical Privileges
Why Is Credentialing So Important?
Medical credentialing is very important for both patients and healthcare providers. Medical credentialing is the only way to maintain the best healthcare standards. It has been reported in the past that 60% of the diagnoses made by doctors were false. It was important to address this issue, and medical credentialing has played a huge role in this regard. Quality of patient care is enhanced through credentialing. Only expert and good physicians are chosen for patient care. By doing so, hospitals ensure that their staff is highly skilled and equipped with enough knowledge to perform the medical techniques. This minimizes the ratio of ill medical practice and decreases the mortality rate.
The Joint Commission, the Centers for Medicare & Medicaid Services (CMS), and other accrediting bodies have obliged healthcare organizations to comply with the regulatory policies. If healthcare organizations hire physicians without credentials, they violate the rules and policies. This behavior can cause them to be charged with penalties and even confiscation of their hospital license. Undergoing hospital credentialing avoids such disasters for the healthcare departments. Recruiting skilled workers also enhances the hospital’s reputation, and insurance companies and patients prefer to get linked with such reputable organizations.
Complete Guide to The Credentialing Process
The credentialing process involves various steps, from application submission to the final result. These steps should be followed if you, as a healthcare professional, want to practice medicine in any organization. Below are steps guide:
1. Application Submission
This process starts with the application submission for the credentialing. Application is available on the websites of the hospitals or credentialing bodies. Candidates need to fill out the application form and attach the mentioned documents, which include educational result cards, training certifications, character certificates, work experience, and much more. These documentations are asked to be checked and verified for originality. There are following documentation which you are asked to provide:
- Health Status And Vaccination Records
- Proof Of All Liability Insurance
- Malpractice Liability Certificates
- Copies Of Licenses
- A Copy Of The CV
- Letters Of Recommendation (LOR)
- Acceptance Of The Bylaws And Regulations Mentioned By The Hospital
- Board Qualification/Certification Status
- Surgical Logs
- Documentation Of Hospital Privileges
- 10-Year Insurance Claims Report
- Updated Curriculum Vitae
- ACLS/BLS Certification
- School Diploma
- Residency Diploma
- Social Security Card
2. Verification Of Credentials
Once the application is submitted to the hospital, the credentialing committee contacts the educational institutes, licensing boards, previous employers, and training institutes to check the legitimacy of credentials. In case of any discrepancy, the application is rejected. The credentialing committee contacts the institutes via phone calls, emails, or posts. This step ensures that fraudulent people are not practicing medicine.
3. Background Check
Apart from checking documentation, the credentialing board committee also checks the personal record of the person. The health status and criminal record of the person are checked manually or using electronic health records. Reviews are taken from previous employers, colleagues, and fellows to check the attitude and behavior of a person towards their profession. This enhances the safety of patients in healthcare organizations.
4. Review By Credentialing Committee And Privileges
The credentialing committee, which is composed of senior staff members and administration members, reviews all the background checks and makes a final decision. If the committee approves hiring a candidate, then privileges are also assigned to that candidate. Privileges are given according to the person’s expertise and skills. A suitable practicing scope of medicine is presented to the healthcare provider.
5. Ongoing Monitoring And Re-Credentialing
The medical field is evolving with the advent of time. New procedures and treatment options are being introduced regularly thanks to continuous research. Healthcare providers need to seek constant education and learn new skills and procedures. Credentialing of the provider is done at regular intervals to ensure that he/she is updated with new education and skills.
How Do We Improve Hospital Credentialing?
1. Clear Policies And Procedures
Transparency and universal rules are the major pillars to ensure the best credentialing process. Hospitals should make clear and transparent policies related to the steps involved, fee structure, eligibility criteria, and responsibilities of the candidate. This practice can help to make the credentialing process efficient and fast.
2. Incorporate Technology
Most of the hospital revenue is lost in the credentialing process because of doing things manually. Contacting institutes for background checks and other steps needs time and resources. It brings a huge burden on the shoulders of the administration. Therefore, technology should be introduced, including blockchain technology, electronic health records, artificial intelligence, online verification tools, and automation software. Both time and money can be saved using these technologies.
3. Continuous Training And Education
Continuous training and education of providers are necessary to remain updated with new policies and treatment methods. Hospitals should hold training sessions, seminars, workshops, and meetings to inform doctors. These steps are very important for the safety of patients and the reputation of hospitals. Providers should be trained to comply with regulatory policies to avoid any kind of irregularity in medical practice.
4. Accountability And Collaboration
A culture of accountability should be adopted by introducing regular audits, open communication, and a transparent credentialing process. Candidates should have access to review each process of credentialing to maintain its integrity. This ensures that all the steps in the credentialing process are accurate and correct.
Hospitals should take necessary measures to promote interdisciplinary collaboration to get accurate information about the practitioners. Collaboration with other departments can help to get the data of their educational records and previous jobs/training.
Who Pays For Credentialing?
The cost per physician goes to around 200$ and this amount is not paid by the healthcare provider who is a candidate. The total cost is paid by the hospital to which the candidate has applied for the job as a healthcare practitioner.
If you are in a private setup and you want credentialing for the insurance company, you will pay the whole cost. If you want to hire a provider to join your team to assist you, you will also pay for the credentialing process of the new guy.
When applying for hospital privileges, physicians must pay the fee themselves. They must fill out the form and manage all finances, and then the committee decides on privileges according to their expertise.
Hospitals usually hire third-party credentialing services for credentialing, and the hospital pays for the services they get. To hire third parties, hospitals should be vigilant only to recruit professionals to avoid resource loss. You can also read our blog to know the in depth knowledge about insurance companies costs for credentialing.
Conclusion
Hospital credentialing is the process of verifying data about a healthcare provider’s education, training, and licenses. This process is done when hiring providers for patient care or when presenting licenses to them for practicing medicine. Credentialing is essential to ensure patient safety and high-quality care. Transparent credentialing of healthcare providers can also maintain hospital reputation and integrity.
Various steps are involved, including application submission, data verification, background check, review by the credentialing committee, ongoing monitoring, and re-credentialing. This step also has many roadblocks, including a lack of technological incorporation, its time—and money-consuming nature, and regulatory changes. Measures should be taken to cope with these hurdles. Technology like AI, blockchain, EHRs, and credentialing tools should be used for efficient and smooth processes.