You can often hear that hospitals use the term credentialing while making decisions regarding its practitioners and granting privileges. These two terms are related, but still quite different.
Basically, the term credentialing means the verification of physician’s education, experience and training. Hospitals may also extent the term to include evaluation of collected data and making a decision about a physician. In this case, hospitals say that a physician has been credentialed as a staff member.
There are many types of credentials, but three main ones are used by all hospitals – licensure and re-licensure, college or university degrees, postgraduate work, certificates and awards. Some hospitals also require a proof that the physician has completed either a defined number of certain patient care treatments under supervision of a professional or an accredited training program for the activity he/she wants to perform. Hospitals perform a thorough check of all physician background information, and can search for signatures of supervising professional, documentation of special training and education, log book’s recordings, etc. To give credentials, hospitals also check fellowship or residency training, board certification, and competency-based education.
Privileging is something different. The term means that a physician has been allowed to perform certain activities in a healthcare facility. It’s important to understand the differences between privileges and membership. Membership means that a physician is a member of medical staff and can attend meetings, vote and receive benefits of the membership. There are also requirements that come with membership, such as attending patients in the department, paying dues, etc. Privileges are required in order to provide treatment to patients.
The processes of privileging and credentialing are defined at hospital’s bylaws and in policies and procedures. Getting credentials and privileges is a necessary part of providing services to patients. Most of the time, the first step in the privileging process is to get an application for privileges. It’s quite common for hospitals to create application packets that include the list of data required to get privileges. The physician submits a list of the requested privileges and proves that his/her credentials are real. The main task of credentialing is to verify the physician’s qualification. Sometimes hospitals can grant temporary approval of privileges, while the credentials are being verified.
Credentialing process is usually held by a credentialing committee, which can also grant privileges. The credentialing committee consists of representatives of physicians who have privileges in that healthcare facility, and they make recommendations about the applicant to the governing body (for example, the medical staff executive committee). Different hospitals may have different committees. They can be composed of medical staff with administrative representation, or be more of an inter-professional group.
In some hospitals, staff is required to take care of the administrative process of credentialing and privileging processes, and then they should send information to the administrative body for a final decision. Besides, demand for credentialing has created many private credentialing services. These services usually help process application packages, verify credentials and send information to the organization.
Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.
© Premier Credentialing Solutions, LLC. An Illinois-Registered LLC. 2016. All Rights Reserved.