Medical credentialing is the process of evaluating the qualifications and practice history of a doctor or other practitioner in the medical field. Ideally, this will give medical facilities the opportunity to find and hire skilled, reliable doctors and, in turn, provide better access to quality health care. The question is: can you really rely on the medical credentialing process?
It is natural to question if this process is really the best for an organization to follow. Is it the best way to determine if the medical professional is best qualified to offer medical care? It is important to examine every aspect of the process to know just how it is helpful.
Medical credentialing includes a review of the prospective employee’s education, training, residency, and licenses. It can also take into account any certifications that have been issued by a board in the doctor’s specialty. All these things must be held up to established standards and closely examined to make sure everything was completed in a competent manner.
Medical credentialing begins by collecting general information on the background and qualifications of the medical practitioner. This includes more than just doctors. Credentialing applies to chiropractors, podiatrists, physical therapists, nurse practitioners, psychotherapists, and anyone else that practices in the medical field.
Then, once this information has been gathered from the medical practitioners, it must be checked against reliable, objective sources, like the National Practitioner Data Bank or the American Board of Medical Specialties. This way personal opinion can be eliminated from the process.
The next step in the credentialing process requires that contact is made with the institutions or organizations that the practitioner has had an experience with. This means contacting the states that issued a medical license to the doctor or the schools, hospitals, and other organizations that the doctor was a part of. This is the only way to make sure there is no limitations imposed on the doctor, and that he or she received and completed all the requisite education and training.
Now that that is done, the review starts. Medical credentialing is more than simply verifying the doctor’s grades while they were in school. It also includes how they have acted and behaved medically during their careers. This means their conduct is examined, as is their history of any malpractice, privileges being revoked, or just any history in general of what they have done over their course of work.
Medical credentialing can get complicated with every state, hospital, and insurance company espousing different rules, forms, and standards. The bureaucracy can really start to get complicated, which is why many companies that specialize in credentialing services have started to appear. It may be difficult, but organizations are learning quickly that the process will help them provide reliable, quality health care.
