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.

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