5 Lessons Learned: Doctors
Things that You Need to Know Regarding Physician Credentialing
The physician offices, hospitals as well as managed care insurance companies and the different laboratories all credential the physicians. You have to know that credentialing is actually the act of gathering information about the doctor or medical provider to verify their qualifications when it comes to practicing medicine in their specialty.
There are a lot of agencies that oversee the credentialing processes. Know that there is a leading agency which monitors the credential as well as the qualification standards in healthcare. The medical providers should go through the credentialing process before they are being hired by the medical facilities as well as the insurance companies. Physician credentialing or medical credentialing is going to verify the training, licensure, quality, education and also the general ethical standing of the provider in a particular medical community.
The process of credentialing is going to start by submitting the required information to the credentialing agency for evaluation. The areas of focus would include the licenses, education, board certification, background check, malpractice claims, resume and the detailed work history, privileges, personal preferences, the malpractice insurance and several others.
The information is collected and reviewed by such physician peer-review committee. Such committees make recommendations to the professionalism as well as the standing of the provider in the medical community. Committees are going to evaluate the ethical behavior of the medical provider.
The insurance companies, which include the government-sponsored payers, will research the physician’s medical credentials before accepting the professional into the group of the participating providers. Those physicians that didn’t undergo credential procedures won’t be allowed to bill for services according to the policies of the Medicaid and Medicare. The managed care organizations have strict physician credentialing process prior to the listing of the provider with the insurance company. So many private physician practices are going to credential the doctors to ensure quality care delivery.
It is through credentialing that the customers can assure that the medical providers were reviewed by the peers. Such would provide much higher level of trust and make sure that the provider is licensed as well as certified and hasn’t had the licenses or privileges revoked by another state. But, such cannot determine the quality of the care offered by the provider. A lot of credential committees actually have policies which the providers should be participating in like the periodic credential updates as well as reviews to update the status.
There are several companies, like the medical practice consultants, which specialize in the provider credentials. Such companies would consult many medical facilities and the provider practices in order to monitor and guarantee that the physicians’ credentials are current.
