Why Should Hospitals Credential Their Providers?

Hospitals and other health care facilities are required to verify the qualification of those who provide services to their patients. In order to ensure patients receive safe and quality care, physicians have to undergo a process, which is called a credentialing. Credentialing process means a practice by which healthcare facilities verify skills and qualifications of their providers to ensure each patient that they possess necessary skills to provide services to patients. Once a physician is credentialed, hospitals have to further investigate practitioner's competence in a concrete area of care, through a process that's called privileging.


The main principle of the credentialing is the responsibility of hospitals for ensuring quality care for each patient. In multiple efforts to reach this aim, healthcare facilities take numerous steps to verify proficiency of their providers through the collection and evaluation of information relevant to the professional performance of the practitioner. These two processes happen after a physician has already met licensure requirements.
In the vast majority of hospitals and healthcare facilities, physician credentialing has two stages. During the first one the hospital checks that the physician has completed education and training, can practice in the state where health care is being administrated, and does not have violations and malpractice issues on record.


Applicant identification is one of the first things a physician has to go through. The application requires a copy of an ID with a photograph. It's also recommended to send a copy of the picture when a healthcare facility requires references from the applicant. This would prove that the applicant didn't use an ID and a photo of another provider. Moreover, in many states it's mandatory to perform a thorough background check on all physicians. This background check differs from verification of provider's data. Many healthcare organizations even hire a third party to provide a comprehensive investigation of court records - both civil and criminal - at the state and federal level.


Hospitals have to collect a lot of information regarding each physician's licensure status, experience, training, ability to perform privileges and competency. Verifying that all providers meet the standards and that there are no questions about their behavior, credentials, references, education and training help filter out troublesome or incompetent candidates. The hospital's bylaws should develop a process for approval and review of all applications and reapplications. All credentialing, privileging and re-credentialing recommendations and decisions have to be documented and approved by the governing board.


Moreover, there are healthcare facilities that require their providers to undergo another credentialing process, which is known as periodic credentialing. This process allows hospitals to double-check the qualification of their physicians.  During this process, hospitals have another opportunity to verify one more time the competency of their providers.


After the credentialing process is done, the hospital gives the physician a permission to deliver services in the healthcare facility, be it cardiology, surgery or anything else. Once the hospital is sure that a physician's competence in his field of practice is real, the physician gets credentials and privileges.

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.

How Can You Protect Your Hospital From Unprofessional Physicians?

It's a proven fact that in order to predict somebody's future behavior one should examine the past behavior of that person. Thus, the best way to hire the most professional physician is by examining his/her background and work history. Below you can find the key components of the successful credentialing process.

Ask about any malpractice issues

Every hospital can create its own application form, and yours should ask detailed information about formal warnings or reprimands, or if the applicant has ever been put on probation. You should clearly explain that omission of any important information in the application can be a reason for an immediate loss of credentials and privileges. You should require the National Practitioner data Bank and review the results searching for evidence of professional misconduct. New recruits should be asked about their professional knowledge and references. If the recruit has references stating anything but good professional behavior, he/she should get in contact with medical staff leader for an explanation. And also a little note about references: always ask new recruits for references that can shed light on the professional conduct of the new provider. If the credentials committee thinks there have been issues with unprofessional behavior, they will contact individuals who could have direct knowledge of the misconduct. It's the applicant responsibility to provide you with honest references and until they are returned, credentialing process is not complete. And if former medical staff representatives or hospital personnel are reluctant to speak about behavioral concerns regarding a physician applying for credentials, ask the physician to provide a specific release stating that he will not bring legal actions if those individuals are forthcoming with information.

Interview potential providers

Interviews are a great way to reveal some behavioral or personality problems. For example, you can ask a physician how he would respond if a nurse observes inappropriate physician conduct in the facility. If the applicant can't acknowledge inappropriate conduct of the physician or won't report it to the hospital leaders, consider it as a red flag. Moreover, those who show immaturity, defensiveness or self-centeredness are prone to unprofessional behavior more than others.

Credential committees can sometimes dismiss red flags on the ground that they're unsubstantiated because they simply can't find information about the applicant's past. As a result, you may end up hiring a problematic physician. However, good credential committees always ask applicants to provide additional references to help deal with concerns. For example, if there are rumors that the applicant has been disruptive elsewhere, the committee can require more letters of reference or interview the director of the previous hospital about the performance of the applicant. Credentials committees can also ask questions, like has this physician ever been disciplined for unprofessional conduct? Has he been the subject of an investigation? The credential committee should know applicant's past experience so they can ask complicated questions while processing the application. They can even ask the applicant to undergo a special evaluation. There are multiple organizations that analyze behavioral problems in applicants.

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.

How Can You Apply For Changes To Privileges?

Getting hospital privileges is a complicated, time-consuming process. However, once a physician gets the privileges, he/she should renew them at least once in two years. In the past, it was done automatically, as long as a physician shows high performance and meets all standards. However, since 2008 hospitals are required to develop their own criteria to renew granted privileges based on different standards, such as patient satisfaction rate, mortality rate, complication rate, and even handwriting legibility. So, keeping privileges is quite a chore for physicians, and the only way to make it a bit easier is to get you acquainted with all steps.

Two parts of hospital privileges re-approval process
Re-application for privileges consists of two parts - re-credentialing process and new privileges determination. Re-credentialing process is held to check one more time if the physician still has skills and qualification to retain his/her privileges. The hospital staff performs another background check, evaluates the physician's performance throughout the year, and verifies training and education. Then you will be given your privileges again, which will allow you to do certain things in the hospital. Sometimes, a hospital allows you to retain all your privileges. However, they can also give your very limited privileges, restricting you to perform only one function or procedure. Or they can grant you with broader privileges, and you'll be able to do almost everything in your specialty, including consult, admitting patients, performing multiple procedures and so on. Moreover, more and more hospitals get associated with a particular practice. And if you don't belong to that practice, your privileges may be reduced or you'll get no privileges at all. That's the modern world of medical politics.

Basically, there are four steps you should go through:
•    Contact the office of your hospital and get their application form
•    Fill and submit everything properly and return it back
•    Follow up to make sure everything goes smoothly and medical staff has everything they need
•    Prior to the privileging meeting make sure you send all recommendations and letters of references

In some hospitals, there are also different types of privileges. Sometimes, you can even choose what is best suited for your practice. Courtesy privileges mean that a physician can admit only a number of patients. It's still enough for medical insurance companies to grant privileges to a physician. In this case, physicians usually don't attend medical staff meetings. These privileges can suit those physicians who don't expect to do procedures or admit patients at the hospital.

Full privileges mean that physicians can admit unlimited number of patients and should perform core procedures of the medical specialty. Physicians also have to attend medical staff meetings regularly.

The vast majority of medical insurance companies require physicians to hold privileges to be allowed to be part of any medical network. Obtaining the privileges isn't the easiest task, but it will prove you can provide quality health care. So, many hospitals help physicians to get their privileges.

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.

How Can You Apply For Changes To Privileges?

Getting hospital privileges is a complicated, time-consuming process. However, once a physician gets the privileges, he/she should renew them at least once in two years. In the past, it was done automatically, as long as a physician shows high performance and meets all standards. However, since 2008 hospitals are required to develop their own criteria to renew granted privileges based on different standards, such as patient satisfaction rate, mortality rate, complication rate, and even handwriting legibility. So, keeping privileges is quite a chore for physicians, and the only way to make it a bit easier is to get you acquainted with all steps.

Two parts of hospital privileges re-approval process
Re-application for privileges consists of two parts - re-credentialing process and new privileges determination. Re-credentialing process is held to check one more time if the physician still has skills and qualification to retain his/her privileges. The hospital staff performs another background check, evaluates the physician's performance throughout the year, and verifies training and education. Then you will be given your privileges again, which will allow you to do certain things in the hospital. Sometimes, a hospital allows you to retain all your privileges. However, they can also give your very limited privileges, restricting you to perform only one function or procedure. Or they can grant you with broader privileges, and you'll be able to do almost everything in your specialty, including consult, admitting patients, performing multiple procedures and so on. Moreover, more and more hospitals get associated with a particular practice. And if you don't belong to that practice, your privileges may be reduced or you'll get no privileges at all. That's the modern world of medical politics.

Basically, there are four steps you should go through:
•    Contact the office of your hospital and get their application form
•    Fill and submit everything properly and return it back
•    Follow up to make sure everything goes smoothly and medical staff has everything they need
•    Prior to the privileging meeting make sure you send all recommendations and letters of references

In some hospitals, there are also different types of privileges. Sometimes, you can even choose what is best suited for your practice. Courtesy privileges mean that a physician can admit only a number of patients. It's still enough for medical insurance companies to grant privileges to a physician. In this case, physicians usually don't attend medical staff meetings. These privileges can suit those physicians who don't expect to do procedures or admit patients at the hospital.

Full privileges mean that physicians can admit unlimited number of patients and should perform core procedures of the medical specialty. Physicians also have to attend medical staff meetings regularly.

The vast majority of medical insurance companies require physicians to hold privileges to be allowed to be part of any medical network. Obtaining the privileges isn't the easiest task, but it will prove you can provide quality health care. So, many hospitals help physicians to get their privileges.

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.

How Can You Apply For Changes To Privileges?

Getting hospital privileges is a complicated, time-consuming process. However, once a physician gets the privileges, he/she should renew them at least once in two years. In the past, it was done automatically, as long as a physician shows high performance and meets all standards. However, since 2008 hospitals are required to develop their own criteria to renew granted privileges based on different standards, such as patient satisfaction rate, mortality rate, complication rate, and even handwriting legibility. So, keeping privileges is quite a chore for physicians, and the only way to make it a bit easier is to get you acquainted with all steps.

Two parts of hospital privileges re-approval process
Re-application for privileges consists of two parts - re-credentialing process and new privileges determination. Re-credentialing process is held to check one more time if the physician still has skills and qualification to retain his/her privileges. The hospital staff performs another background check, evaluates the physician's performance throughout the year, and verifies training and education. Then you will be given your privileges again, which will allow you to do certain things in the hospital. Sometimes, a hospital allows you to retain all your privileges. However, they can also give your very limited privileges, restricting you to perform only one function or procedure. Or they can grant you with broader privileges, and you'll be able to do almost everything in your specialty, including consult, admitting patients, performing multiple procedures and so on. Moreover, more and more hospitals get associated with a particular practice. And if you don't belong to that practice, your privileges may be reduced or you'll get no privileges at all. That's the modern world of medical politics.

Basically, there are four steps you should go through:
•    Contact the office of your hospital and get their application form
•    Fill and submit everything properly and return it back
•    Follow up to make sure everything goes smoothly and medical staff has everything they need
•    Prior to the privileging meeting make sure you send all recommendations and letters of references

In some hospitals, there are also different types of privileges. Sometimes, you can even choose what is best suited for your practice. Courtesy privileges mean that a physician can admit only a number of patients. It's still enough for medical insurance companies to grant privileges to a physician. In this case, physicians usually don't attend medical staff meetings. These privileges can suit those physicians who don't expect to do procedures or admit patients at the hospital.

Full privileges mean that physicians can admit unlimited number of patients and should perform core procedures of the medical specialty. Physicians also have to attend medical staff meetings regularly.

The vast majority of medical insurance companies require physicians to hold privileges to be allowed to be part of any medical network. Obtaining the privileges isn't the easiest task, but it will prove you can provide quality health care. So, many hospitals help physicians to get their privileges.

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.

How Are The Physician Privileges Determined?

All patients want good, skillful, qualified doctors. Naturally, hospitals want the same. That means that being a licensed physician is not enough to get hospital privileges. Hospital privileges can be called prescriptions that allow physicians to perform a certain set of operations and procedures, or even admit patients. As hospital executives say, without privileges, a physician can't be considered qualified.


There are several regulatory bodies - including Medicare, Department of Health and Senior Services, and Joint Commission on Accreditation of Healthcare Organizations- that hold healthcare facilities responsible for appropriately granting privileges to every physician before he can start practicing in the facility.


Getting hospital privileges is a complicated, tedious, and detailed process. But hospitals have to ensure patients get the best care. Physicians go through the similar process at all hospitals across the country, and each hospital is required to make an independent decision about the individual physician.


Before a physician, or any doctor, can treat patients in the facility, they have to fill out and submit the application asking for permission to practice at the hospital. They also have to obtain a permission to carry out certain procedures and treat patients at the hospital.


All of the physician's credentials - residences, education, training, experience, and fellowships - are carefully reviewed for appropriateness of competency and training. Most of the time, applications are verified by medical staff services and also reviewed by the leading physicians of the hospital.


Medical department's chairman and Credentials Committee set recommendations about special privileges and appointment to the staff. Then, their recommendations are reviewed by the Medical Executive Committee, and their results are sent to the Board of Trustees, which decide whether they approve the application or not.


If a physician meets all the guidelines and requirements, then he's granted privileges that he appear to be properly trained to carry out. Physicians can even obtain privileges to work in several hospitals, but the majority chooses to stay in one facility. However, privileges can be denied if the hospital decides a physician doesn't have a proper training or doesn't demonstrate competency. Besides, exclusion from Medicaid or Medicare, loss of medical license, or having found of abuse or frauds are reasons for withdrawal of hospital privileges. Privileges can also be suspended when a physician doesn't treat enough of patients to stay proficient or doesn't perform enough of procedures.


Physicians should state which specialty they want to practice, and all materials are sent to the chosen specialty. Then physician committee evaluates the application and makes the suggestion. However, the board decides whether or not grant privileges to the physician. If an employment contract allows, a physician can join more than one medical staff. Most often, a physician is needed at many hospitals when the specialty is narrow. It also helps to build the patient base and maintain professional skills.


Hospitals privileges are also required by many insurance companies that won't allow participating as a provider in the provider panels otherwise. For hospitals, it's also beneficial to grant privileges. It allows them to treat certain patients, improve medical equipment and generate revenue.


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.