Simple Guide For Establishing Credentialing Process

Simple Guide For Establishing Credentialing Process

As a board member, you probably understand the commitment your healthcare facility has to the local community to ensure highest quality care is delivered at your hospital. But do you know the impact of this commitment at every meeting when you grant privileges or give credentials? Physician credentialing is the crucial task you have to undertake to ensure your patients receive safe and quality health care.

Simply put, the main aim of credentialing is to ensure only professional doctors are allowed to be among the medical staff, and that they deliver procedures within their competence and experience. The credentialing process involves establishing realistic requirements and evaluating physician's qualifications for obtaining a certain status. The first step of credentialing includes considering and agreeing on professional experience, training, and other requirements that physicians have to meet in order to get credentials. The second step includes obtaining and verifying information about the skills and qualifications of every physician. In other words, credentialing process is needed to prove that each physician:
• provides honest and complete information
• has all licenses
• has malpractice insurance
• meets the standards established in a particular hospital

In the past, credentialing required applicants to present only several papers, such as their certificate or diploma. Nowadays, however, it's much more complicated and requires verification of primary sources - schools, licensing agencies, residency programs, etc. - to guarantee that physicians' training, education, licensure and other papers are legitimate. Primary source verification is important in both meeting standards of accreditors and avoiding possible legal problems.

One of the key aspects of the credentialing process is granting privileges to an applicant. Granting privileges is a three-step process, which are:
• determination of treatment and diagnostic procedures that a hospital is staffed and equipped to perform
• setting the minimum experience and training needed for a physician to carry out the procedures
• evaluation of whether or not a physician meets the requirements and allowance of performing requested procedures and treatments

Delineation of privileges refers to a process that determines what treatments and procedures can be performed at the hospital. As new technologies are implemented, privileging physicians become more difficult and challenging for hospitals. Delineation of privileges should be flexible, so that hospitals can add new conditions to treat and new procedures, but it also should be consistent, fair, and firm.

To start the credentialing process, the board should specify criteria that will be used to make decisions at each step. The board should also make sure that the process is fair, consistent, functions properly, and thorough.

Then the board should decide which physicians will be allowed to enter the medical staff or remain there, and which conditions they may treat. In the past, boards' role in the credentialing process was insignificant, but today they are directly involved in the process.
Verifying information provided by a physician protects patients and reveals any details that could stay hidden 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
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©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  All Rights Reserved.

Physician Credentialing Requirements

Physician Credentialing Requirements

The governing body of each healthcare facility is responsible for credentialing process and can delegate some responsibilities to the staff of the hospital for proper implementation. Qualifications to provide treatment and care to patients that are verified include: checking with NPDB, or the National Practitioner Data Bank, confirming current professional licenses, confirming board specialty certifications, checking with HIPDB, or the Healthcare Integrity Protection Data Bank, CSA (Active Controlled Substances Act) database and other databases, confirmation of membership in associations, and confirmation of degrees.

Hospitals may implement different credentialing criteria, but there are still some requirements established in the vast majority of hospitals. It includes competence, character, judgment and experience.

In many states, hospitals also require an active collaborative practice agreement that should be on record before credentialing. This agreement refers to a relationship between a collaborative physician and the NP. It allows NPs to independently care for his patients within given guidelines and according to regulations. When you successfully complete all the paperwork, the hospital will verify that they believe in your qualifications and provide you patient care at the facility. However, re-credentialing is needed every 2 years, so it's vital to maintain all documents and papers.

Privileging refers to a process by which the same hospital that approves your credential application grants permission to provide some aspects of patient care. For example, privileging may include prescribing, admitting and performing some procedures. Sometimes, a physician may be trained, credentialed and licensed to provide patient care by the Nurse Practice Act, but usually your practice is limited by the privileges you got within the facility.

In additional to health care institution credentialing, a physician should also be credentialed by nonprofit and for-profit insurance companies and Medicare and Medicaid programs, which are sponsored by the government. Health insurance organization credentialing will allow you to bill for care provided. The paperwork may vary quite dramatically, but most of the time, you should obtain a National Provider Identifier number, which will recognize you as a unique health provider and also as the one who can maintain licensure and certifications. You can apply for the National Provider Number at the US Department of Health and Human Services. Once you have it, your power and validity as a health provider will increase.

As an applicant, you also have your rights. In particular, you have the rights to be informed of the following:

• Right to correct mistakes, conflicted information and erroneous
• Right to review the information you submitted for credentialing
• Right to get informed of the status of your application, upon request

You should direct all questions and request to the consultant at the hospital you're going to practice in. However, you won't be notified if your application has errors or mistakes and can be simply denied without telling you the reason. Therefore, check your application multiple times to ensure it is error-free and provide comprehensive information about you and your working experience. You're the only one who can correct conflicting information and errors.

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 Most Important Provider Enrollment Regulations

The Most Important Provider Enrollment Regulations

On March 2011, new requirements for the HCA (Health Care Authority) were implemented by the Affordable Care Act. These requirements include additional screening requirements for referring providers, disclosures, application fees, and re-credentialing for all providers every five years.

The HCA collects application fee according to the federal rule ($352) from providers before executing the provider agreement. There are some providers, who are exempt from these fees:
• Providers that have paid fees to Medicaid
• Individual providers
• Providers that enrolled under Medicare

Re-enrollment is necessary for all physicians who want to treat patients and have privileges. Re-credentialing includes filling up the application form, attaching all documentation (with updated information), and paying application fee. You'll get a receipt that will mean the beginning of re-credentialing process.

Provider Enrollment on the Portal, or PEP, helps complete the application more thoroughly and carefully and guides you through the entire credentialing process. It has an online application form, where PEP automatically populates identical data field, which shortens the time to finish the applications and refuses errors and mistakes. Besides, it doesn't allow you to submit the application before you fill out all required information. If your information is not consistent, your application will be denied. Before, you had to sign the application yourself, but now with an E-signature feature, you can sign the application online. You can also correct information online, which wasn't possible before. You have 30 days to change information if needed. And one of the most important features is tracking. In the past, providers had to call to the credential manager to find out something about the application. Today, you can receive updates to the e-mail.

There are also new disclosure requirements. Now, HCA is required to collect data about controlling interests of providers, disclosures of ownership, managing employees and helping providers during credentialing process and re-credentialing process. All disclosures should include the name, social security number, and date of birth of the disclosed providers. Everything is collected in the Disclosure Statement and in the HCA's Provider one online application system.

All health care facilities have to complete a financial report presented by an individual accountant of the facility. All documents, notes and schedules as required by the American Institute of Certified Public Accountants should be presented in the report.

If the facility doesn't prepare the report, it should at least provide a statement of revenue, statement of cash flows, changes in earning, and balance sheet. Sometimes audited statements can be in a consolidated format, and may not be audited.

HCA may obtain and use your medical information. It can collect information about you in many different ways. For instance, HCA can get your data when you apply for payment, enroll in UMP, call Customer Service, send claims, or submit appeals or complain. This information can be related to medical care or some general data.

HCA is required to keep this information confidential. It doesn't disclose it to the third parties and can't give it to the providers.

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.

Thoroughly Explained Physician Credentialing Process

Thoroughly Explained Physician Credentialing Process

Credentialing process for a hospital is a difficult task, concerning the amount of documents that have to be checked before accepting a provider into the facility. For that reason, you should know how to properly perform a credentialing process.

To begin the process, make the list of pote
ntial applicants. Define those physicians who you think will invest in the facility, but keep the list short. If your center is multi-specialty and the owning entity says the ASC is going to have an open staff, you should go through all specialties and find available physicians. After that, one of the staff members will have a meeting with those physicians and determine whether or not they want to apply for credentials.

The next step is to collect correct contact information. Some physicians want the ASC to go through a nurse or managers, other prefer to be contacted directly. Up-to-date information is a simple thing that can cause lots of troubles if you don't have it. You will have to check in with the chosen physician throughout the credentialing process and send multiple forms, so make sure you have a database of current contact information.

Now it's time for the most time-consuming part - background check. This is the most troublesome task in the credentialing process since one of your staff members should go through all information and then verify that it's accurate and complete. This includes:

•    Verifying employment history
•    Verifying education and training with help of American Medical Association
•    Reviewing time gaps in career and asking to provide explanation if a physician has a gap longer than 6 months
•    Asking the National Practitioner Data Bank about settled and closed claims history
•    Using OIG sanctions database to verify Medicare sanction information
•    Verifying the status of privileges at other health facilities

Once all this information has been checked and verified, you can move to studying references and determining whether or not this physician can treat patients in the facility.

Check if there are any malpractice claims

While checking information through the National Practitioner Bank, you may find information on closed suits, settlements, and other malpractice claims history. If a physician has a malpractice claim, it doesn't mean he shouldn't be credentialed. It's a red flag, but if physicians have closed suits and malpractice claims, it just means you should apply scrutiny to the application.
After your specialist has confirmed the information in the application, it should be sent to the governing body for a final check. By this time, all red flags should be discussed.
Create a list to track the progress of chosen physicians.

You and your credentialing coordinator should keep checking the progress of the application. It's better to do checks weekly and make sure your coordinator knows when forms were sent to the physicians and when they submitted all information to the facility. Besides, your coordinator should also keep track of all references that haven't been responded.

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 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 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.

How To Make Sure Of The Doctor Experience And Qualifications

How To Make Sure Of The Doctor Experience And Qualifications

Credentialing process usually mean that a hospital aims to optimize the utility of their crucial recourses - providers - and ensure highest quality patient care possible. The concept is quite old and slowly getting easier, thus more and more hospitals try to perform a thorough credentialing process and creating new quality standards.
Professionals determine credentialing as the process of collecting, verifying and evaluating qualifications and skills of healthcare providers who want to provide patient care services in a certain healthcare facility. Each hospital has its own set of standards and requirements that their providers have to meet. Credentials mean evidence of training, education, licensure, skills, experience and other qualifications.
There is also a process called privileging that accompanies credentialing. Privileging means a process by which healthcare organizations allow practitioners to perform a certain set of services related to their specialty, based on thorough evaluation of their credentials. Credentialing and privileging ensure medical quality; they help assess initial qualification and prove competence.
Verifying quality care
The importance of credentialing can't be underestimated and hospitals have to credential their providers to ensure quality care. It's vital to maintain the high standards of medical care, thus regular verification of qualification and re-credentialing ensure patient safety, provision of quality health services and reduction of possible medical errors.
Hospitals are expected to provide quality care through accurate diagnoses and proper treatment of their patients who come to get the services. Medical providers are the ones who deliver these services and their level of competence and knowledge determines if the patient receives appropriate care.
The credentialing process also ensures that hospitals act according to current laws, state and federal requirements and standards of other certifying organizations that relate to operation of hospitals with regard to the recruitment of its practitioners. Credentialing helps prevent the hiring of a candidate with fraudulent training and degrees to the hospital. After getting credentials, privileging process ensures that practitioners are allowed to perform a certain set of procedures under supervision at the hospital.
Basics of the credentialing process
Professionals believe it's better if every hospital develops its own standards and documents of this process, thus it's impossible to find a guide with all steps that will describe norms and procedures of the process. However, there are many similarities in processes of different hospitals; they mainly differ by specific characteristics of each facility, such as recourses, patients served, etc.
The only way to determine the qualifications of medical providers is to get information about their education, training, and licensure, and to review their data in details. The methods that hospitals use to accomplish this difficult task should become routine as the medical staff becomes familiar with them.  The hospital has to be sure that its patients are treated properly and that it hires only qualified practitioner, who would perform certain services to the patients.
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.

Important Steps to Physicians Credentialing

As a physician, you already know how important the credentialing process and privileging is. These are two aspects that ensure patient safety and high-quality service, but do you know how to apply for it?

Step one - collecting necessary documents

All physicians work hard to become who they are and credentialing (a complicated process of confirming the qualifications of the practitioner) is the most important part of your ability to perform quality services to your patients. Credentialing simply means the verification process that confirms that you, as a physician, have all qualifications, credentials and background for membership in a healthcare organization (such as a hospital).

The credentialing process includes the confirmation of all professional degrees, licensures, clinical training, training certificates, residence certificates, continuing education credits and many more. All these documents are needed to confirm whether or not you meet the latest standards of practice and regulations set by each institution.

The most common documents that you will need:
• Proof of identification
• Proof of DEA licensure
• Proof of education and training
• Work experience
• Military service
• Board Certifications
• Letters of Reference
• Health Status
• Hospital affiliations
• Criminal check
• Malpractice insurance
• Claims history
• Sanctions disclosures

Unfortunately, there is no centralized credentialing process, so it can get quite complicated and time- and money consuming. You have to create different submissions for every entity, have to keep off the records and make sure that everything is error-free.

Step two -applying for privileges

When you're done with credentialing, it's a perfect time to apply for privileges. It's a process that grants you with an authorization to provide specific services or treatments at a certain healthcare facility. Privileging can be divided into three main categories:
• Admitting privilege that allows you to admit patients to the hospital
• Courtesy privilege that allows you occasionally to admit and treat patients at the hospital
• Surgical privilege that allows you to operate room surgeries

This is an important step in physician credentialing since it ensures the healthcare facility that you have the experience, skills and competencies necessary for the services you're going to provide. Once the privilege is approved, you can conduct certain services in a certain facility. For example, a doctor in private practice may want to apply for privileges to perform surgeries, and can even get privileges from more than one facility. Moreover, hospitals are also obliged to answer regulatory entities like Accreditation of Healthcare Organization or The Joint Commission on Accreditation to ensure all physicians are properly privileged at the facility.

Record-keeping is an important part of successful credentialing process

Just as credentialing, the privileging process is long and complex. You will have to provide a lot of details, prove your education, competency, fellowships, residence, licensure, insurance and many more - and get ready to different interviews with the committee and a board of directors: that is an essential part of any investigation process. Both credentialing and privileging are documented, formal procedures that require adherence to every rule and regulation for granting clinical privileges and admission. This means they are the key parts of delivering patients the highest standard of 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.

©  Premier Credentialing Solutions, LLC.  An Illinois-Registered LLC.  2017.  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.

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.

How to Avoid the Most Common Credentialing Mistakes?

Credentialing process is a necessary part of a successful physician practice with steady cash flow and patient referrals. Avoiding these common credentialing mistakes will make the process move more quickly and efficiently.
Providing incomplete information
The most common mistake many physicians make is a lack of attention to small details. Errors and mistakes in application lead to delays and even denials. Different healthcare facilities may have different application forms, but typically you need to submit your phone, tax, address, services provided, contact information, employment history, copies of licensure, patient profile and legal troubles regarding your practice if you have any.
What can you do? Thoroughly check your application a couple of times to certify its accuracy before sending it to the credential committee. Getting everything right the first time means you get credentialed much faster.
Not following up
Be prepared that your plans can be backlogged with the credentialing process. Do everything you can to confirm that your application was successfully received and know where it is. If something sounds like complete nonsense to you, ask questions and wait for the response. Many physicians have no idea of where in the process their application is and what each stage means. Make sure you have no more questions before accepting the answer.
Follow up from time to time and don't forget to make notes. E-mail your contacts, phone if you need to and check all web directories. Never call to explain delays or notify about updates. The only way for you to find out something about the application is to follow it up regularly. Make it a routine and keep up until your application is approved. Remember that you're the one who is concerned about the process.
Don't allow CAQH lapse
If you already have a CAQH profile, you know that it should be updated regularly. Always keep up-to-date all contact information and re-attest your data. You should act proactively when you receive an updated insurance, license, DEA or any other document and get everything loaded to your profile with new expiration dates. It will help avoid delays in the process of re-credentialing.
Not knowing the standards and guidelines
Application forms in Medicaid, Medicare and other government health programs are completely different. They all have standard forms that must be appropriately filled out and sent to the intermediary. These applications, then reviewed against very strict standards. Many physicians make the same mistakes in the following:
• Using outdated/irrelevant applications
• Using incorrect forms
• Submitting incomplete applications
• Submitting to the wrong intermediary
• Not submitting required forms
• Not using verifiable practice location as a practice address
• Not signing the application in all fields
Not giving enough time
Many physicians start too late and this is a reason for their failure. You really need to give yourself at least 3 months. The responsiveness of your application will be determined by the motivation to add a new doctor to a team and the workload.
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.

Why Should Hospitals Credential Their Providers?

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


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


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


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


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


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

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.

How Can You 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.