Step-By-Step Credentialing Manual

Credentialing process is a necessary evil every physician has to go through. Postponed or done haphazardly until a month before a physician starts working, it can turn into scheduling nightmares, cash-flow delays, and other unpleasant things. Fortunately, there are several steps to minimize the possible issues with credentialing. The following steps are quite simple, yet proven.

Start well in advance

Though an average credentialing process can be finished within 90 days, give yourself at least 6 months. As payers have supersized, an ability to expedite an application has disappeared. Physicians have to work on a timeline of someone else, usually payers, and each payer has different timelines for processing an application. So, be patient and wait.

Pay a lot of attention

Credentialing managers say that the most common mistake in applications is that they miss information that's crucial for processing. Outdated, incomplete, or missing data usually appears in the following fields:
• malpractice insurance
• attestations
• hospital privileges
• current work status and work history
If you provide a comprehensive list of your training, education, experience, etc., you will probably avoid the vast majority of delays. Getting everything right the first time means you'll get a new physician credentialed within 90 days.

Get yourself acquainted with CAQH

CAQH, or the Coalition for Affordable Quality Healthcare, created a uniform credentialing program 15 years ago. Since then, many payer across the country gave adopted the program. Physicians who update and attest with it find credentialing and re-credentialing processes much easier and faster. CAQH doesn't allow you to follow temptation and leave data entry boxes empty or send an incomplete application. It's important, because applications with missing information are simply rejected. Because credentialing decisions take months, you'll lose a lot of time and have to do a lot quickly. So, with CAQH you'll attach all required documents and provide all information. And never try to simply remember important dates and events - always have your documents with you.

Link a start date of a physician

This can be a bit controversial, since many hospitals are afraid of offending a new physician by asking to submit the requisite credentialing paperwork. However, it's quite comfortable to link a start date to the submission of the paperwork. For example, the date might be at least 3 months away. It's better for both hospitals and physicians, who at least will know a preliminary schedule of the credentialing process.

Know all regulations and laws

Different states have different laws for credentialing, including in-state credentialing (a physician change one practice to another within one state doesn't have to go through all credentialing process again), and reciprocity regulations (if a physician was credentialed in another state, sometimes he/she will have to repeat the process). Usually contacting local medical society or association is enough to get all necessary information, avoid mistakes and use laws to your advantage.

Credentialing can be tedious, especially if you don't provide enough information from the very beginning. Hospitals make strong efforts to gather all data from new physicians, and when done properly, credentialing is a much less painful than it might be otherwise.

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.

The Process of Physician Credentialing

The Process of Physician Credentialing

Credentialing is a system that establishes contacts between health plans and providers. However, it's riddled with redundancy, and many organizations collect identical information. An average physician spends at least 3 hours every year to submit 18 credentialing forms, and staff spends over 20 hours reviewing them. If you're not going to work in cash-only medical practice, you will have to go through a credentialing process. However, you can handle your part more efficiently. Follow the steps below not to get mired in this process.

Start well in advance

The credential process is not among quick ones. When a new physician is joining the team, you should plan everything months in advance. The same applies if you're a newly recruit associate. The problem can appear when many organizations start asking for the same documents needed for the credentialing process. With that in mind, don't be surprised that it takes weeks to process all paperwork, so if you overlook any request for information, it may cause financial problems, since you can't bill for your services. So, it's important to tie the start date of a new physician to the successful signing of all key documents. Even if you don't want to bother yourself with this and outsource credentialing to somebody else, this person should be able to travel to the physician’s home to get a copy of another document, or escorting a physician to the bank and have all documents notarized, if that's required.

A sustainable process is a key to success

It's understandable that the initial submission of all documents leaves people exhausted, but you still have to make sure everything goes smoothly and you know where all your documents are. Re-credentialing is always somewhere around the corner. There are two main options for handling the workflow, and they depend on the amount of money, time and staff you have (or don't have). You can create a spreadsheet of hospitals, payers and third parties and record there all submissions and deadlines. You can assign an employee to keep all forms signed and updated. Another option is to lease (or purchase) a credentialing software or outsource the entire process to one of the vendors that specialize in this field. Whatever you choose, you should always monitor the process.

Learn about the most important success factors

There are special credential databases, such as CAQH Universal Provider Data source, that won't let you leave any field in the form blank. Remember that with a small detail missing in the form may be rejected. One decision can take several months, so take time to complete every element, and attach all necessary documentation. And don't even try to estimate start and end dates or other data from memory.

Decide what steps you can take in the interim

Some people believe that it's fine to bill under other identification while waiting for the decision of the credentialing process. In fact, this can lead you to serious legal problems if an adverse event happens - the name of the rendering physician won't be the same as the name listens on the medical claims. Besides, some health plans strictly prohibit this protocol of billing under another physician. One of the most common ideas physicians have is to use a -Q6 modifier and bill a physician as a locum tenens. But the best thing you can do here is to learn what is required for credentialing and follow all instructions precisely.

A helpful indicator of a properly running credential process is the record of denials and adjustments that are taken during the billing process. Keep track of the claims denied and the accounts written off, because of incomplete credentialing.

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 Perform The Criminal Background Check During The Credentialing Process

How To Perform The Criminal Background Check During The Credentialing Process

Credentialing means a process of collecting, verifying and evaluating the qualifications and skills of physicians to provide quality care services for a healthcare facility. There are three main components of the process: education and relevant training, current licensure, and current competence, which allows to perform certain procedures and treatments.
Credentialing committees have to deal with credentialing applications daily, but how can a criminal background check complement this process.

Background check and credentialing

Medical staff service is a governing body of a healthcare facility and is responsible for working with independent physicians who serve the hospital. Many physicians appointed to provide services are not actually employed by the hospital, and that's why human resource department doesn't perform the background check and verification of provided information. But the credentialing committee does. The background check is an analysis of criminal records, education verifications, professional licensures verification, training verification, and that's just a few components out of many. For the credentialing committee, the process of granting credentials also includes verification of clean background information. They check peer recommendations, malpractice claims and insurance statuses. The goal is to protect patients from unqualified physicians.

Background check is a risk mitigation tool

While medical service doesn't perform the same employment activities as the HR department, they perform a thorough background check on all physicians applying for credentials or privileges, since it's one of the best ways to mitigate risks for the hospital and protect its patients from preventable serious mistakes.

Checking a criminal history (if any) on a physician performing procedures on the patients can save your reputation. While in some states medical board can perform the criminal background check on physicians applying for licensure, not all of them are allowed to do it. However, even if they have the authorization to perform background checks, they may have limited access to different databases. Moreover, medical board may not perform a thorough check and fail to define troubled physicians. So, without a background check, you may overlook some serious records of a criminal history.

One background check may not be enough

Even if the medical board performs a background check on physicians applying for privileges at the hospital, they can't prove physicians haven't committed any crimes since then. Even if there is a medical staff office at the hospital and they perform their own check, it shouldn't be done only once. To reduce risks, the trend in healthcare facilities for constantly performing background checks is emerging. For example, many hospitals re-check the background criminal history every year, to minimize levels of risk for the healthcare facility. Some hospitals perform a re-check of background information every two years, and a lot can happen during this time. As many experts explain, a criminal background check is a snapshot in time - it's always possible to find something new in future, something that you didn't find on the first background check performed during the credentialing process.

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.

Things To Consider Before Starting Credentialing Process

Things To Consider Before Starting Credentialing Process

Credentialing is a popular term among providers, especially among physicians who, just ten years ago, could simply perform cash only services. In contrast, nowadays patients are demanding that providers accept their insurances for payment. Hence, those who don't want to lose clients and scare potential patients away should go through the credentialing process.
Getting credentials mean filling out and retrieving multiple applications with insurance companies, then submitting everything to them, and then constantly following up. Even though it may sound simple, many would agree the process is nightmarish as it usually doesn't go smoothly, and many providers have to submit their applications multiple times, spending time contacting insurance companies and fighting delays and rejections. Moreover, many panels can simply say that they don't accept people with your specialty or they are full.
While the credentialing process will never become one of your favorite things to do, there is still something you can do to make the credentialing a bit easier.
Create a list
Research all insurance companies and choose those you want to get credentials from. Each company has its own credentialing process, so be prepared to submit different application forms and go through multiple interviews.
Complete the CAHQ
The Council for Affordable Quality Healthcare, or CAHQ, is usually required to complete the credentialing process. Almost all big insurance companies, like Aetna or BCBS, use CAQH applications. Thus, you should get yourself acquainted with the system.
First of all, you can't simply upload your information on CAQH, you need to be invited there by an insurance company. And if you remember that "chicken or the egg" thing, you can imagine how it feels when you need to submit an application to an insurance company. Once you submit it, you should call them to check if they actually received anything and generated a CAHQ number for you. And then you can go to CAHQ and complete the application that you have already sent to the insurance company, which is waiting for the complete application to arrive.
Never submit CAHQ applications on paper
Even though you can choose to either submit an online application or send it on paper, never choose to send papers. First of all, their application is over 50 pages long. And second of all, when you send your application on paper, CAQH hires a data entry person to transfer your data. And if you think it takes a lot of time...they just never do it. Many physicians have submitted their applications on paper and CAHQ simply lost them. And if you call to CAHQ, they will also ask you to submit the application online.
Devote around 10 hours for each insurance company you want to get credentials from
Don't expect that getting credentials will only take ten minutes of filling out the application. Usually, you need to spend 10 hours of labor for every insurance company. It includes getting and filling out forms and applications, organizing documentations, and checking the process of credentialing.
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 Does The Affordable Care Act Mean For Americans?

The Affordable Care Act, or Obamacare, will reduce prices for health coverage making it accessible for millions of Americans. Almost 60 million Americans live without insurance, and the law addresses issues concerning inequalities in affordability of health care services, increase access to affordable, quality health coverage, invest in wellness, and give people control over their health care.
According to researchers, there are higher rates of disability, mortality and chronic disease in rural areas. For that reason, the Affordable Health Care Act will transform the insurance industry to improve the health of rural Americans.

Health Insurance Marketplace and rural coverage
At the beginning of 2014, almost 8 million rural Americans under age 65 got new opportunities to get affordable health care through the Affordable Care Act. Just think of the numbers:
• Almost 20% of uninsured Americans live in rural areas
• The vast majority of rural Americans lack proper health care compared to urban Americans
• Rural Americans usually have lower income level, thus subsidized insurance coverage through Marketplaces is necessary
• the Health Insurance Marketplaces should increase competition in rural areas - especially in those states where one insurance company dominates more than a half of the insurance market
• Residents of those states that are expanding Medicaid will get affordable coverage
The Marketplace will lower costs due to increased competition. It will influence rural areas the most, since at least one out of every five residents there faces medical debts and families have to cover almost 50% of the health care payments out-of-pocket.

The Affordable Care Act for Rural Americans
Uninsured Americans from rural areas can use the Marketplace to compare different insurances based on benefits, quality, price, and other factors knowing all premiums and cost-sharing amounts, which should help them pick the perfect health insurance plan that will fit their needs. Each insurance plan should at least cover all essential health benefits, such as emergency and inpatient services, prescription of drugs, behavioral health treatment, and pediatric care.
New coverage options with insurance benefits are already there for rural Americans:
• More than 30 million Americans now can expand preventive services without cost sharing. Among these services, there are blood pressure screenings, well-child visits, mammograms and pap tests for women and flu shots for adults and children
• Over 11 million disabled rural Americas who get coverage from Medicare now also can access different preventive services without cost sharing, such as colorectal cancer and diabetes screening, prevention plans, bone mass measurements, and many others
• More than 600,000 rural Americans below 26 now are covered under individually purchased plans or their parent's employer-sponsored plan
• Private insurance policies can't have lifetime limits anymore, and annual limits should be more than $2,000,000.
• Americans under age 19 cannot be denied coverage due to a pre-existing condition
Insurances won't have to be cheap, but they certainly will be less expensive and you don't have to pay unexpected costs out of the pocket as if you did without insurance. There are also tax breaks for families with low incomes, which help pay for their insurance.

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.  2016.  All Rights Reserved.

What is Board Certification?

What is Board Certification?

To practice medicine, physicians have to be licensed by the state in which they're going to work. However, licenses don't guarantee that doctor has qualifications to practice a specific specialty, such as surgery or dermatology. One of the best ways to find out about doctor's qualifications is to know if he/she is Board certified and actively participates in activities to learn about the latest advances in patient care and medicine.

Board Certified physicians voluntarily meet requirements beyond licensing. These physicians show the expertise by obtaining Board Certification through the member Boards that all are part of the American Board of Medical Specialties or AMBS. Before a physician can be Board Certified, he/she has to complete:
•    a training leading to a DO or an MD degree from a medical school
•    four years of education in a university or college
•    five years of experience in a residency program

In the past, boards granted physicians with lifetime certificates, so once they were certified, they got it for life. However, nowadays physicians have time-limited certificates and require frequent recertification. The vast majority of boards require recertification after 5 years with some exceptions. Hospital requirements for certification usually vary, which is based on physician availability. There are areas with an abundance of physicians, thus hospitals require thorough verification of qualification and skill, but in underserved areas, hospitals may not ask for a board certification.

When certification is necessary, physicians should keep track on expiration dates of their certificates. Besides, hospitals' bylaws should clearly define the requirements for board certification and develop a process that will verify the certification. Sometimes, the medical staff requires the certification within a given timeframe or on the appointment, which means that physicians should keep track of their documents and assure they meet the standards. Hospitals usually send reminder letters prior to the expiration date of a current certificate. Whether recommendations are applied, they should be fair and consistent.

Board certification can be verified by collecting information from the board. There are also more convenient ways: board certification for ABMS is verified using the CertiFacts website, and many other certifications can be verified online.

However, hospital's governing body has to make sure that under no circumstances clinical privileges in the facility depend on only upon certification, membership or fellowship in a society or a specialty body. In other words, hospitals have to perform a thorough check of background information and qualifications of physicians even if they have a certification. A hospital can require a board certification when thinking of a DO/MD for membership. However, they should not rely on the fact that a DO/MD is or isn't board certified in making a final decision in membership. In addition to the board certification, hospitals should also verify other criteria such as character, training, judgment, and competence. After a thorough evaluation of all criteria, if these criteria are met except for certification, the hospital can decide to select or not to select a physician to the staff.

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.

What Is Negligence In Credentialing?

Negligence means a guilty conduct because it falls short of what a person would do to protect another person from a preventable harm or risk. If a healthcare facility could possibly foresee that a physician isn't qualified and the physician injures a patient, the hospital is separately liable for the negligent privileging and credentialing of the physician. Healthcare facilities are legally responsible under multiple theories. Some of them have been held responsible for the failure of the thoroughly screen a physician through the processes of credentialing and privileging, or for negligent credentialing. Negligent credentialing is recognized by at least 28 states. However, there are other theories under which hospitals are held responsible.
Liability theories
There are states where negligent credentialing falls under the corporate negligence doctrine or corporate liability. The main idea of the theory is that when patients enter a hospital they do so with a reasonable assumption that the hospital will try to cure them. Hospitals have the duty to make a lot of efforts to monitor and evaluate the treatment and care administrated and prescribed by the providers practicing in the facility. Hospitals are also responsible for granting privileges only to professional, competent physicians.
The governing body is responsible for making final decisions in credentialing and privileging matters. Although the Board Certification can also be partially responsible, since they verify physician's information regarding his/her experience and training, the ultimate decision-making power belongs to the governing body.
There are two doctrines that make hospitals responsible for hiring unqualified providers. Patients can't choose the practitioners, so it's a healthcare facility who should carefully decide who can be a member of the organization and who can't.
Elements of Negligence
Patients should understand that the fact a hospital didn't credential a physician adequately doesn't mean that the healthcare facility was negligent. For instance, if the hospital can't verify medical licenses for a competent and qualified physician within the requirements of the credentialing standards, this shouldn't be seen as negligence.
In order to establish negligence, one should analyze specific elements. For example, there should be a duty to exercise due care, and duty must be breached. There is also has to be an injury, and the breach of duty should be a reason of the injury. Besides, the patient bringing the charges has to prove that the injury caused him/her compensable damages.
As it was illustrated in a previous example, let's imagine that a physician injured a patient and it was proved that the injury was a result of negligence. If it was proved that the healthcare facility failed to verify the experience, qualification, and competence on initial appointment, and if it would have found that physician's licensure was suspended, only then it can be assumed that proper credentialing wouldn't lead to the injury. In this example, it's pretty easy to conclude that the breach of duty to properly credential that physician could have led to the injury of a patient.
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.

The Difference between Privileging and Credentialing

The Difference between Privileging and Credentialing

You can often hear that hospitals use the term credentialing while making decisions regarding its practitioners and granting privileges. These two terms are related, but still quite different.

Basically, the term credentialing means the verification of physician's education, experience and training. Hospitals may also extent the term to include evaluation of collected data and making a decision about a physician. In this case, hospitals say that a physician has been credentialed as a staff member.

There are many types of credentials, but three main ones are used by all hospitals - licensure and re-licensure, college or university degrees, postgraduate work, certificates and awards. Some hospitals also require a proof that the physician has completed either a defined number of certain patient care treatments under supervision of a professional or an accredited training program for the activity he/she wants to perform. Hospitals perform a thorough check of all physician background information, and can search for signatures of supervising professional, documentation of special training and education, log book's recordings, etc. To give credentials, hospitals also check fellowship or residency training, board certification, and competency-based education.

Privileging is something different. The term means that a physician has been allowed to perform certain activities in a healthcare facility. It's important to understand the differences between privileges and membership. Membership means that a physician is a member of medical staff and can attend meetings, vote and receive benefits of the membership. There are also requirements that come with membership, such as attending patients in the department, paying dues, etc. Privileges are required in order to provide treatment to patients.

The processes of privileging and credentialing are defined at hospital's bylaws and in policies and procedures. Getting credentials and privileges is a necessary part of providing services to patients. Most of the time, the first step in the privileging process is to get an application for privileges. It's quite common for hospitals to create application packets that include the list of data required to get privileges. The physician submits a list of the requested privileges and proves that his/her credentials are real. The main task of credentialing is to verify the physician's qualification. Sometimes hospitals can grant temporary approval of privileges, while the credentials are being verified.

Credentialing process is usually held by a credentialing committee, which can also grant privileges. The credentialing committee consists of representatives of physicians who have privileges in that healthcare facility, and they make recommendations about the applicant to the governing body (for example, the medical staff executive committee). Different hospitals may have different committees. They can be composed of medical staff with administrative representation, or be more of an inter-professional group.

In some hospitals, staff is required to take care of the administrative process of credentialing and privileging processes, and then they should send information to the administrative body for a final decision. Besides, demand for credentialing has created many private credentialing services. These services usually help process application packages, verify credentials and send information to the organization.

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 To Effectively Manage Credentialing Process

How To Effectively Manage Credentialing Process

Ensuring that your providers are credentialed is the crucial part of saving the practice. From education background to clinical research to board certifications, a lot of data must be collected and verified for each physician to confirm that they meet necessary qualifications of a healthcare specialist.

Have a look at the new recruit's data

When you're recruiting, try to align the credentialing process and the recruitment. Most employment contracts are built on the fact that the employer should get credentialed, thus if the physician doesn't get credentialed, that's a disaster for all parties. The leader of the hospital is 6 months behind in hiring a new physician and reputation is ruined for bringing a provider who can't meet the standards. The new physician may have relocated the job and waiting for a paycheck that will never come. Besides, he can even sue the group for failing to provide the promised job. And when providers don't get credentials, private insurance companies, Medicaid or Medicare can refuse to pay for certain procedures, reducing your incomes. Therefore, its leader's responsibility to check all physician's references, background information and demand explanation for any questionable data before offering the job.

By reviewing all gaps in employment, malpractice issues and references you can make sure the physician won't have problems with the credentialing process. Sometimes, credentialing committees ask for additional information and explanations. It can be asking simple questions about any given reference, or reviewing malpractice suits. The committee can also send documents to a third party for an independent check.

Keep all information in one place

Get credentialing software to keep all information secured inone place and allow staff to view the credentialing process and tasks that need to be completed. With provider's data and supporting forms connected in a single accessible record, your staff can rapidly provide and update their information. Besides, many different credentialing programs notify you about licenses that are near expiration, so you can proactively manage re-credentialing process as well.

Hospital credentialing is not the easiest process to complete, but at least it is more serious and organized now than it was before. However, new physicians still have to provide all applications and forms during the process. And hospitals must protect their patients. It's their responsibility (even though they have to rely on physician references), and hospitals can get sued over poor credentialing or end up in a court when a physician has its privileges removed.

What are the chairman's responsibilities during credentialing process?

It's chairman responsibility to investigate all the skeletons. If you're recruiting a physician who has some questions on the records, devote some time and get all the details explained, so that you won't have to fight problems during the credentialing process. If there is something that looks like regret, now it's time to search for another recruit. But if you still believe that the physician provides quality care, spend some time discussing all the problems with the credential committee to see what they need in order to finish the credentialing process.

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 To Find A New Provider?

How To Find A New Provider?

If you want to change a doctor, you should go through a seemingly simple process - leave one doctor, find and see another one. When you think you have enough reasons for changing providers, you'll want to be sure you get the perfect one. If you don't do everything the right way, you may have a lot of headaches when it comes to finding a person who can meet your needs.

Things to do before you leave your current provider

If finding a new doctor is not mandatory and just your choice, perform a little search to be sure there are candidates that suit your needs. Some doctors don't take Medicaid patients, others don't treat new patients. Skillful specialists are booked months in advance, and you need to spend some time finding a new doctor before leaving another behind. Don't forget to schedule a visit with your current doctor. Take notes and ask a report on recurring and current conditions. If possible, take a new provider with you. You can also explain reasons for leaving - even in big cities the community of specialists is small and you don't want any rumors about your hospital.

Your leaving doctor should give you all copies of medical records that relate to chronic or current problems of the patients, which can be useful for a new doctor. Besides, it's required by HIPAA government policies that you can access this information. However, there are different laws in each state about health records, and how they should be carried out. Besides, if your doctor prefers EMR (electronic record keeping), then you can ask your new doctor to use the same system and alter the process. Once you've had a conversation with a leaving doctor and collected all copies, you can start to get a new one.

Visiting the new provider

Assuming that you have a replacement for the leaving doctor, there are necessary steps to develop the right relationships with the provider. Make an appointment with the new doctor and talk generally - it's better than talk while having sick patients or discussing problems at work.
You already have all the copies, but it's a good practice to have a second set of the records so that you have one set and your new doctor has the second set. If possible, send the copies as soon as possible and don't give them during your first meeting - it's better to have more time to talk rather than to read documents.

Think about the questions you want to ask your new doctor and write them down. It's up to you if you want to tell the new provider why you left the other one behind. If you decide to share this information, remember that it's a foundation for the new relationships. Discuss everything politely and respectively. You need a professional relationship, and that's going to be the start.
Once you work with your new doctor, remember that you need to invest a lot in the relationships. Your new provider will help your patients, so it's your responsibility to provide them with quality health care.

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.

Main Aspects of the Affordable Care Act

Main Aspects of the Affordable Care Act

The Affordable Care Act, or ObamaCare, is the reform law that improves and significantly expands access to curbs and care spending through taxes and regulations. The main focus of the Affordable Act is to improve the quality of health insurance and health care, provide more Americans with access to affordable insurance, regulate the whole industry, and reduce health care spending in the country. There are hundreds of different provisions in the law that addresses multiple aspects of the healthcare crisis. It's understandable that you may not want to read the entire law, so below you can find the most important facts you need to know about ObamaCare to ensure you don't pay additional fees and get affordable coverage.

According to the Act, Americans who make less than 400% of the FPL (federal poverty level) will qualify assistance subsidies. There are three forms in which the assistance comes: cost sharing for reduced out-of-pockets costs, premium tax credits for reduced premium costs, and both CHIP and Medicaid. All in all, the Act contains more than thousand pages about new reforms for health care and insurance industries in order to reduce health care costs and provide affordable insurance for Americans. However, even though the law is long and complex, first 200 pages contain the most interesting information.

Before the Affordable Care Act, anybody who had been sick in the past (a pre-existing condition) could be simply denied treatment or coverage, or be charged much more because of the gender, or be dropped somewhere in the middle of the treatment because of a small mistake in the application. Moreover, you had literally no way to appeal insurance company rules. Now, Americans have a larger number of benefits, protections, and rights concerning their insurances.

In 2013, almost 45 million Americans didn't have a health insurance, which is 16% of the population. Those were working families who just couldn't allow the insurance. ObamaCare's main aim is to help those individuals to get insurances by offering cost assistance and expanding Medicaid eligibility. As a result, at the end of 2014 only 13% of Americans couldn't obtain the insurance. By 2015, the rate was below 10%.

The Act dramatically reforms Medicare. For instance, one of the changes is offering Medicare recipients the same rights, protections, and benefits as others, and reforming its system such as cut off redundant aspects. Remember that Medicare is not the part of the marketplace, and if you have Part A or C you're covered.

The Affordable Care Act requires large employers to provide their full-time workers with health coverage. Non-exempt Americans have to keep essential coverage the whole year or pay fees every month they go uninsured. The minimal coverage you need to have to avoid fees is the minimum essential coverage that can be obtained during the enrollment period.

Simply put, now everybody can get insurance regardless of previous health conditions. However, there is one exception: individuals with those health plans that were purchased before March 23, 2010, and have a pre-existing health condition don't have to cover costs related to their illness.

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 To Choose The Best Physician Credentialing Software

How To Choose The Best Physician Credentialing Software

The current shift from fee for service to fee for quality has attracted bigger audience to health management. Those healthcare organizations who want to ensure efficient clinical delivery base should have started consolidating clinical providers at higher rates. Hence, new credentialing software is needed to handle all the complexities of multi-provider, disturbed, quality driven reimbursement model. The proper credentialing software has to offer are venue-centric solution and help healthcare organizations meet their financial and operational needs that healthcare management requires.

24/7 accessibility

Before buying credentialing software, go through all its features and evaluate if it can perform everything you need. At the very least, it should have 24/7 accessibility, so you can get your credentialing data at any time. All information should be stored in the cloud where healthcare managers can identify where they are in the credentialing process and ensure you aren't losing revenue on delayed applications. Moreover, being in a cloud means a reduction in capital expenditures since there is no need for another software, servers and hardware to subsidize the credentialing system.

Financial performance and payer operational metrics

Another important feature is institutional, financial performance and payer operational metrics. It means that leaders and managers of a healthcare institution can identify how the facility is performing from the financial and operational perspective. It also allows evaluating provider's individual performance. As any leader knows, understanding performance of providers is the first step of improving financial performance.

Generated work list capabilities

As a leader of a healthcare facility, you should require system generated, flexible work lists that your staff can use to meet their credentialing demands. No more calendars and post-in notes that remind you about stages of the credentialing process. The efficient credentialing software will help you go through each step quickly and without mistakes. Besides, healthcare leaders can easily evaluate the work of their providers and establish different metrics.

Assurance tools and mechanisms

The ability to track and monitor credentialing processes of the providers is a necessary feature of credentialing software. Quality monitoring and staff training should be ongoing, don't just leave it be.

Productivity tracking tools

Credentialing software should be able to track statistics and productivity metrics. What is your staff doing on a weekly, daily, or hourly basis? Are these just miss-guided, pointless efforts? The ability to track productivity metrics makes providers more efficient and ensures you're not losing revenue.

Combined credentialing concepts and revenue cycle

Understanding financial impact of the credentialing process helps meet the demands of health management initiatives. And when you know the impact, you'll see if you're losing revenue because providers aren't credentialed properly.

Revenue management

Credentialing software should give you suggestions that help ensure profits and sustainable growth of the facility. Keep all the processes streamlined and build a close network to keep your facility going.
Investing time and money in advanced credentialing software is always a good idea. Otherwise, you risk facing credentialing denials and lost 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.

What's Important To Know About The Credentialing Process?

Physician's credentials - certificates, diplomas and licenses on the wall - tell patients about their professional skills and qualification to treat them. In the US, professional organizations, state and local governments establish the credentials that physicians need to provide their services.


Practitioners are credentialed and then privileged - healthcare facilities verify education, license, and qualification - upon hire and then every two years. Physicians can get privileges after thorough evaluation and verifications of the training and education they have presented. Privileges allow physicians to give the care treatment and services by the facility to the patients.


The most important thing to know about the credentialing process is that there is no national, standardized system for credentialing physicians. Each state and local government is responsible for deciding what physicians have to provide to get credentialed. Those credentials may vary quite a lot from state to state and among different disciplines.


Patients should note that certificates, licenses, and regulations can't guarantee effective, safe treatment from any physician - complementary or conventional. Tell your physician the complementary health approaches you prefer. Tell them everything you do to take care of yourself. This will ensure safe and coordinated care.


Apart from credentialing, you could also hear about certifying and licensing. Credentialing is the broader term that refers to doctor's license, certification, or education. Professional organizations give certifications, government agencies grant licenses. Note that being certified or licensed doesn't mean being qualified.


The vast majority of states use the approaches below to credential doctors:
•    Title licensure: requires doctors to obtain credentials prior to using a title
•    Mandatory licensure: requires doctors to have licenses to treat patients
•    Registration: requires doctors to provide information about professional education, experience, and training


To get a license, you should carefully read requirements of each state. Among everything else, they may ask you to:
•    meet certification requirements
•    graduate from a certain program
•    pass exams
•    Complete a training program


The services you're allowed to provide also vary from state to state. For example, some states don't allow acupuncturists to recommend diets to patients, while others recommend doing it.


Some professional organizations offer additional certification examinations. Certifications qualify doctors for local or state licensure. For instance, in some states, doctors who don't have an M.D., have to be certified by the National Certification Commission if they want to be licensed.


Educational programs in the US train physicians and prepare them for future certification. The Department of Education authorizes specific organizations to accredit training programs for doctors.


The credentialing processing time varies from one organization to another. Sometimes plans take 6 months to complete the process and then 50 days for contracting, while others need 3 months to finish everything. When you submit documents for contracts, enrollment or follow-up on your application, it's important to keep track of the process by utilizing fax logs, certified mail, and documenting all conversations. Once the credentialing process is complete, you will be offered a contract and will be able to treat patients in the facility.


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 Long Does It Take To Complete Physician Credentialing?

It's quite common that a new physician joins your healthcare facility either from another practice or out of residency. It's the time when you have to deal with many managed-care organizations or MCOs, so your new physician needs to be credentialed.

This process requires a lot of time and effort. First, you have to collect all documents from the provider - from valid state license to hospital privileges to confirmation of malpractice insurance. Then you have to wait at least 30 days (but it usually takes longer) for the MCOs to check and verify documentation before the new physician can be added to the panels. During this time, the physician is not allowed to treat your care patients. At least, the physician will not be reimbursed for treating, which dramatically limits the ability of the physician to create revenue for your facility. At this point, many start asking why this process takes so long. Is there any way to reduce delays? Below you can find some tips to help you and your facility.


Why is this process so long?
There are many reasons for delays, but the main ones are MCO's desire to match the NCQA (National Committee for Quality Assurance) standards and inefficient planning on the part of practices and physicians.
One of the NCQA standards that are called the Initial Primary Source Verification stipulates that the MCO should verify several documents, like records of professional liability settlements, prior to assigning credentials. When the MCO really wants to meet this standard, they make withhold credentials from a new physician until the very last detail is verified.

Poor planning is also a popular reason for delays. Quite often, new physicians don't start credentialing process until they arrive at practice, even though they've started filling the applications months earlier. And there can be a huge delay since collecting references can take months and then weeks until they arrive. Until all information arrives at the MCO, an application cannot be considered complete - and while it's not complete, the credentialing process is stalled.

For that reason, many healthcare facilities require submitting application at least 90 days before the physician's start date. The processing time can take less than 90 days, but it's a benchmark since it allows extra time when some documents can't be verified in timely manner or discrepancies is required.

You should just keep in mind that credentialing process will take as long as needed to collect all information, receive board recommendation and verify all sources. It's hard to estimate the minimum or maximum frame for the credentialing or privileging process, which both may take longer than three months. Medical staff bylaws, which define privileging and credentialing processes, specify that applications must be acted upon a certain period of time. Some credentialing applications may be finished faster than others, and it always takes longer if the primary source can't be verified, if a physician omitted information or made mistakes on the application, or if there are red flags that require careful investigation.

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.

Why Is Privileging Important?

 

While we all hope that our doctors have the highest qualifications, there are cases when patients suffer inappropriate care. At many hospitals across the country, where quality care is their biggest concern, medical staff always struggle with the task of properly privileging their physicians.


There are at least two reasons for this. The first one is medical board requirements and rules that vary in each state, making it quite difficult to hire physicians from different states and develop credentialing standards. The second one is that appropriate privileging training has sometimes been inefficient, mainly due to the lack of appropriate healthcare facility's resources and personnel.
However, hospitals still stick to the privileging process and try to make it as easy and quick as possible. Below there are the main reasons for granting privileges, and how to make this process more pleasant.
Understand the importance of the process
Every healthcare facility should understand that no provider can be allowed to provide services until he/she has successfully met the requirements of a privileging process and proved the competence and experience. Hospitals should begin by collecting applications that have all necessary information (for example, certification and training). Then this information should be verified through reliable sources to ensure that this physician data is valid.
Complacency cannot lead the privileging process
The very first goal of any reliable healthcare provider is to deliver the highest quality patient care, thus hospitals have to go through all necessary steps to develop a perfect and clear privileging process and reevaluate and update the process to ensure the best results. Evaluating new physicians and assigning proper privileges can take a lot of time even under the best circumstances. The better your process is, the sooner you'll grant privileges to a physician, thus the sooner he/she will start treating patients and brings you more revenue.
Look outside the box
When you're evaluating credentials applications and files, having everything done properly and get all the documents is quite important, but it is not a guarantee of success. Sometimes physicians don't include information that is as important as data that is included, and it can require a well-trained credentialing expert to get rid of useless information and find important nuances in physician's life and practice.
Appropriately trained credentialing specialist is recommended
Lack of privileging success is quite often due to incomplete, insufficient, or improper resources and personnel. Unfortunately, erroneous or incomplete decisions based on fake information (which results in granting privileges to an incompetent provider) can compromise the quality of patient care. It's really important that a hospital takes all appropriate steps and has the most highly trained staff.
Explain to your staff the importance of privileging process
It's vital that your committee members, physician leaders, board members and senior management understand the importance of privileging. Obtaining their support will kick off the whole process on the right foot and dramatically improve chances for success. For healthcare providers that provide honest information and meet the standards, the result of the process is predictable. And when you get a perfect physician, he/she assures the highest quality care possible.
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.