9 Lessons Learned: Doctors

Posted on Posted in Health Care & Medical

Important Information that You Should Know Regarding Physician Credentialing

Physician offices, the managed care insurance companies and the hospitals as well as the laboratories all credential their physicians. Know that credentialing is actually the act of collecting the information about the doctor or the medical provider in order to ascertain their qualifications when it comes to practicing medicine in their specialty.

There are many agencies which oversee the credentialing processes. There is one leading agency that monitors the credential and the qualification standards in healthcare. Medical providers must go through the process of credentialing before they are hired by the medical facilities or 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 credential process of the doctor would start with the medical provider submitting information to such credentialing agency for evaluation. The areas of focus are malpractice claims, board certification, education, licenses, resume, background check, resume as well as detailed work history, personal preferences, malpractice insurance, privileges as well as other information.

The information is collected and reviewed by such physician peer-review committee. The committees would make recommendations to the professionalism and also 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. 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 do have a firm physician credentialing process before the provider would be listed as participated with the insurance company. A lot of private physician credential the doctors to guarantee quality care delivery.

Know that provider credential is one way to assure the consumers that the medical providers have been reviewed by the peers. This would also provide such higher level of trust and ensure that the provider is licensed and also certified and hasn’t had their licenses or their privileges revoked by the other state. However, you must know that this can’t measure the quality of care that the provider is able to provide. Many of the credential committees do have policies which the providers need to participate in the periodic credential updates as well as reviews to keep the status current.

So many companies actually specialize in the provider credentials like the medical practice consultants. Such companies would consult with the medical facilities and the provider practices in order to monitor and also ensure that the physicians’ credentials are kept updated and current.