What Does Credentialing Mean For A Patient?

What Does Credentialing Mean For A Patient?

Nowadays, it's really important to understand the meaning of credentialing and what means when a physician is credentialed or have privileges to treat you. If the physician doesn't have one or both, it can mean treatment options for you are strictly limited.

Unsurprisingly, every patient searches for a competent and appropriately trained physician. Unfortunately, fraud is something to be aware of. For example, in California, two unqualified individuals posed as doctors which led to patient harm.

That's why patients should know about credentialing - a process, that verifies qualification, training, and practice history of a physician, which protects patients from being duped. It also protects you from those providers who had sanctions levied against their license. To get credentials, physicians should fill out an application and submit it, but prior to that he or she should make sure no little detail is missing. Work history and specialty boards are one of many things that should be carefully checked before submission.

Copies of all documents - residency certificates, medical degrees, etc, - should accompany the application. Physicians should also provide professional references that can prove the competency. A declaration, which confirms that the physician has never been fired from a job for competency issues, is also required. All in all, there is a long list of documents that should be provided in order to start the credentialing process. Among them, there is a confirmation of not being an addict, convinced felon or hasn't been disciplined for illegal or questionable activity. Then every hospital has a committee that reviews the application and then grants or declines privileges and credentials to provide services in the facility.

Before the committee grants credentials or privileges, all information is thoroughly checked and verified. This makes sense, because too many people make mistakes, embellish or even lie on their applications. For example, the biggest fraud in history is lying about graduation from one of the best Universities and having a Ph.D. The job of credentialing committee is to check up on all the details. In the example above, that person managed to hoodwink all verifies and was picked up much later by accident.

Physicians should also go through the process of -re-credentialing at least every three years, although they can do it more frequently. Re-credentialing is necessary to provide all changed information for verification. This process is almost identical with the credentialing process; however, practitioner's work history, education, and training aren't verified. Re-credentialing is necessary to check physician complaints and sanctions, so that they can react on safety and quality issues that arise.

Simply put, credentials are a proof of skills and competence. Verification of all licenses, education, training, insurance, identification and all history related to professional activity doesn't leave a chance of fraud. It may sound quite simple, but this process is really complicated and time-consuming and physicians have to go through all this to get verification. Those physicians, who understand that this process is necessary, care both about the facility and patients. And patient safety should always be the first priority.

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.  2017.  All Rights Reserved.

How To Go Quickly Through The Application Process Of Credentialing

Provider credentialing is not just filling multiple forms; it's an ongoing, complex process, which is extremely important for every healthcare facility. Without proper credentialing, physician reimbursement for services can be denied, or, at least, delayed. Given its deadlines, many steps and uncertainties, physician credentialing is critical for hospital's practice.

Put simply, credentialing means verification of your expertise, experience, willingness to provide quality care, and interest. Many professionals describe credentialing as obtaining hospital privileges, as well as enrolling in health plans as a participating physician. Even after submitting multiple forms and documents to different third parties to verify your information don't think everything is done. Even though health plans and hospitals don' require a re-hashing of the process, many oblige physicians to submit their updates annually. It means, credentialing process never stops, it consumes hours each year, and especially if you don't follow it properly.

Although a lot of people now use CAQH and different credentialing software to reduce paperwork, many hospitals still prefer managing everything manually or using electronic databases that can't be connected to other systems. The process is usually not flawless and a lot of time is spent researching and maintaining credentialing files for physicians.

Not only completing all application takes a lot of time, but hospitals spend even more time to perform the credentialing process. Unless you're going to work in a cash-only practice and forget about hospital privileges, you should try to find ways to make the credentialing process faster and easier.

Whatever you do, don't expect that everything will go smoothly. You should start planning months ahead, especially when new physician is joining your staff. Unfortunately, many organizations require the same documents needed for credentialing process at the same time. With that in mind, you should allow enough time for every organization to process their own paperwork. A physician who ignores your request for additional credentialing information can become a financial problem - he/she simply can't bill for services. Consider trying an initial paycheck or a new start date to successfully gather, submit and sign all documents. Even if you prefer outsourcing credentialing to third parties, you still need a person to pursue the process - somebody who can go to physician's home to get a copy of the diploma or deliver all documents to the bank to get them notarized.

While initial submission of all applications can be quite time-consuming, it's important to make sure that somebody maintains all forms because re-credentialing is coming soon. Many hospitals can't support a lot of credentialing managers, so there are not that many options for them to handle the workflow. The easiest and the cheapest option is to create a spreadsheet of payers, third parties and hospitals that should be constantly updated and have all deadlines and requirements. Or hospitals may assign one of their employees to monitor the credentialing process and take actions to get data gathered and forms signed. Regardless your decision, always monitor the effectiveness of the process to ensure you're getting your money worth.

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.  2017.  All Rights Reserved.

What is Credentials Verification Organization?

What is Credentials Verification Organization?

Credentials verification organizations, or CVOs, gather and verify necessary information about practitioner's education, background, experience, training, skills, and competence, just like a traditional medical office in a hospital would. Nowadays, there are over 100 CVOs in the US, and the vast majority of them are certified or accredited by the National Committee for Quality Assurance, or NCQA, or Utilization Review Accreditation Commission, or URAC.

Some of the first CVOs were just agreements between the groups of hospitals in a local community to jointly share available information about applicants. One medical staff office was required to confirm training, education, and residency, gathering references, verify certificates and licenses, etc., and then send information for use in other hospitals. Later on, with the advent of the databank, it was decided to make multiple inquiries for the same doctor acting as an agent for many hospitals. As time passed by, both non-profit and for-profit organization also entered the business.

Don't confuse CVO with other organizations that just gather, store, and disseminate professional information given by practitioners. There are common applications that can't be used for the process of verifying all information and those organizations can't collect additional information needed for the credentialing process and executive committees. Simply put, CVOs acts as an agent of providers to verify, collect, store and disseminate information about the professional history of the practitioner. Licensing and accrediting organizations don't require CVOs to be certified or licensed, just like hospitals don't require to be accredited. CVO seeks out accreditation to assist in marketing activities and distinct one practitioner from another.

A hospital may assign any organization as an agent for gathering and verifying practitioner's information, provided that the hospital has decided that this information can be collected and verified so that it meets all requirements of a hospital and various accreditation agencies and licensing organizations.

When an organization is certified by URAC or accredited by NCQA, the hospital may accept this accreditation without any evaluations or investigations. If the organization isn't certified or accredited, the hospital has to conduct an evaluation and investigation of the structure, outcome, and documents of the organization. It can be done either in an internal memorandum or in contact.
URAC and NCQA are the only organizations that are allowed to certify or accredit CVOs. None of the organizations that accredit hospitals (such as DNV, TCJ, and HFAP) can approve or accredit CVOs.

For those hospitals who really want to perform their due diligence, there are some questions that will help start the process. For instance, does the organization have a physical location? Does it maintain liability insurance? Or Does it have articles of incorporation? If you're satisfied with the answers, you won't have licensure and accreditation problems that usually appear from complete reliance on data provided by the CVO. If you have established a CVO as a part of the hospital system, it will be considered as a parent organization and its findings can be relieved upon just like it happens with a traditional medical office.

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.  2017.  All Rights Reserved.

How To Protect Patients Through Privileging

How To Protect Patients Through Privileging

Doctors sometimes have to make life-changing decisions. Patients trust doctors assuming that they have enough knowledge to make these decisions - knowledge gained through proper training and experience. And privileging proves that doctors have the experience and training they claim and can be trusted. It keeps patients safe, and eliminates potential treatment errors. Moreover, if the hospital should have known or knew that their doctor is not qualified enough to treat patients which led to an injured patient, the hospital is liable for giving privileges to that doctor.

Privileging refers to a decision whether or not a physician is allowed to practice within a particular healthcare facility and provide some procedures in a specific clinic. The privileges given to a physician can't be broader that the activities of a certain hospital. Most of the time, privileges copy the set of individual activities a physician is licensed or qualify to perform. Privileges are always site specific since they require consideration of its characteristics like equipment, site size and capacity, number of medical staff, and other resources to ensure the provision of quality health care.

All physicians who provide services which require certification, licensure, or other credentials are required to have those credentials. All privileged physicians performing services have to have appropriate licensures and exclusion status check.
In order to make the right decision about whether or not to approve an application for clinical privileges, physician's credentials are analyzed and aligned with:
•    Site ability to deliver safe patient care of the activity that should be privileged
•    Patient need for the activity that should be privileged
•    Assessment of experience, education, training and maintenance of skills necessary for the safe delivery of privileges
•    Resources available in the facility to provide or support the activities

In a process of getting privileges, a physician will always go through the credentialing process, since there always should be a thorough examination and verification of his skills, education, training, etc. However, if a physician has credentials it doesn't necessarily mean he has privileges.

The purpose of the evaluation of each physician is to determine that a new recruit has all qualifications and competencies to be granted specific privileges, or if it's a current staff member, to determine whether the privileges should be discontinued, continued, or revised. Once the appraisal of individual physicians is done, medical staff will provide recommendation to the Governing body and they will decide whether to grant a particular physician privileges.

Every hospital has to ensure that appropriate hospital departments, patient-care areas and the practitioners are aware of the privileges granted to the practitioner. Hospitals should also inform the physician about the revocation and revision of the privileges. Moreover, there are state and federal law regulations that require hospitals to inform appropriate federal and state authorities, databases, and registries, as well as the National Practitioner Databank about practitioner's privileges being revoked, limited, or constrained in any way.

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.  2017.  All Rights Reserved.