What You Need to Understand About Physician Credentialing
The physician offices, hospitals as well as managed care insurance companies and the different laboratories all credential the physicians. You must know that credentialing is one act of collecting information regarding the doctor or the medical provider to ascertain their qualifications in practicing medicine according to their specialty.
Know that there are many agencies which actually oversee the credentialing processes. There is a leading agency which monitors the credential and also the qualification standards in healthcare. The medical providers should go through the credentialing process before they are being hired by the medical facilities as well as the insurance companies. Know that physician credentialing or medical credentialing is going to verify education, training, licensure, quality and also the general ethical standing of the provider in a medical community.
The credential process of the doctor would start with the medical provider submitting information to such credentialing agency for evaluation. The areas of focus are malpractice claims, board certification, education, licenses, resume, background check, resume as well as detailed work history, personal preferences, malpractice insurance, privileges as well as other information.
The information is collected and then reviewed by a certain physician peer-review committee. The committees would actually make recommendations to the professional as well as the standing of the provider in the community. The committees would also evaluate the ethical behavior of the physician.
The insurance companies including the government-sponsored payers, will look for the physician’s medical credentials before accepting the professional into a group of participating providers. The Medicaid and the Medicare will not permit the physicians not undergo the credential procedures to bill for services. The managed care organizations have strict physician credentialing process prior to the listing of the provider with the insurance company. So many private physician practices are going to credential the doctors to ensure quality care delivery.
It is through credentialing that the customers can assure that the medical providers were reviewed by the peers. Such would provide much higher level of trust and make sure that the provider is licensed as well as certified and hasn’t had the licenses or privileges revoked by another state. However, you must know that this can’t measure the quality of care that the provider is able to provide. So many credential committees implemented policies that the providers must participate in like periodic credential updates and reviews to keep the status current.
There are several companies, like the medical practice consultants, which specialize in the provider credentials. Such companies would consult with the medical facilities and the provider practices in order to monitor and also ensure that the physicians’ credentials are kept updated and current.
Source: Physician Enrollment