What You Need to Understand About 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. Know that physician credentialing or medical credentialing is going to verify education, training, licensure, quality and also the general ethical standing of the provider in a medical community.
The credential process of the doctor would start with the medical provider submitting information to such credentialing agency for evaluation. The areas of focus actually include board certification, education, licenses, malpractice claims, background check, resume with a detailed work history, personal references, privileges, malpractice insurance and others.
The information gathered are going to be reviewed by a physician peer-review committee. The committees would actually make recommendations to the professional as well as the standing of the provider in the community. The committees would also evaluate the ethical behavior of the physician.
The insurance companies including the government-sponsored payers, will look for the physician’s medical credentials before accepting the professional into a group of participating providers. The Medicaid and the Medicare will not permit the physicians not undergo the credential procedures to bill for services. Managed care organizations do have such strict physician credentialing process before the provider is listed as participated with the insurance company. A lot of private physician practices would credential the doctors to make sure of quality care delivery.
Know that provider credential is one way to assure the consumers that the medical providers have been 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 a lot of companies, such as medical practice consultants, specializing in the provider credentials. These companies consult with the different medical facilities and the provider practices to monitor and make sure that the physicians’ credentials are always updated.