Thoroughly Explained Physician Credentialing Process

Thoroughly Explained Physician Credentialing Process

Credentialing process for a hospital is a difficult task, concerning the amount of documents that have to be checked before accepting a provider into the facility. For that reason, you should know how to properly perform a credentialing process.

To begin the process, make the list of potential applicants. Define those physicians who you think will invest in the facility, but keep the list short. If your center is multi-specialty and the owning entity says the ASC is going to have an open staff, you should go through all specialties and find available physicians. After that, one of the staff members will have a meeting with those physicians and determine whether or not they want to apply for credentials.

The next step is to collect correct contact information. Some physicians want the ASC to go through a nurse or managers, other prefer to be contacted directly. Up-to-date information is a simple thing that can cause lots of troubles if you don’t have it. You will have to check in with the chosen physician throughout the credentialing process and send multiple forms, so make sure you have a database of current contact information.

Now it’s time for the most time-consuming part – background check. This is the most troublesome task in the credentialing process since one of your staff members should go through all information and then verify that it’s accurate and complete. This includes:

•    Verifying employment history
•    Verifying education and training with help of American Medical Association
•    Reviewing time gaps in career and asking to provide explanation if a physician has a gap longer than 6 months
•    Asking the National Practitioner Data Bank about settled and closed claims history
•    Using OIG sanctions database to verify Medicare sanction information
•    Verifying the status of privileges at other health facilities

Once all this information has been checked and verified, you can move to studying references and determining whether or not this physician can treat patients in the facility.

Check if there are any malpractice claims

While checking information through the National Practitioner Bank, you may find information on closed suits, settlements, and other malpractice claims history. If a physician has a malpractice claim, it doesn’t mean he shouldn’t be credentialed. It’s a red flag, but if physicians have closed suits and malpractice claims, it just means you should apply scrutiny to the application.

After your specialist has confirmed the information in the application, it should be sent to the governing body for a final check. By this time, all red flags should be discussed.
Create a list to track the progress of chosen physicians.

You and your credentialing coordinator should keep checking the progress of the application. It’s better to do checks weekly and make sure your coordinator knows when forms were sent to the physicians and when they submitted all information to the facility. Besides, your coordinator should also keep track of all references that haven’t been responded.

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.

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