What Is Physician Credentialing?

As you may have heard previously, credentialing is essentially a process taken by healthcare organizations to evaluate things like the qualifications, experience, and even just the general capabilities of the healthcare professional you hire.

Ultimately, the main goal here is to ensure that all the physicians at your practice are meeting the rigorous (yet essential) standards set by the regulatory bodies and insurance companies in California – thus guaranteeing their expertise and how capable they are at delivering care.

Still, as hinted at, this is far from a seamless process, and some of the intricacies and challenges involved in the healthcare provider credentialing process cannot be understated.

Whether it’s the incessant paperwork, regulation adherence, or even finding the time the ensure it all goes smoothly, it’s a fairly convoluted process. So, in this article, we’ll be looking to simplify the healthcare credentialing process for your physicians, ensuring they’re properly qualified for the role. Let’s get started!

What is Physician Credentialing?

In basic terms, physician credentialing is the general process of verifying and evaluating the professional background of all the physicians working at healthcare facilities.

This isn’t a process that can be dealt with promptly, unfortunately, due to the assortment of documents that need to be considered during the assessment. For instance, the physician’s education, where they trained, licenses, and even a past history of disciplinary cases have to be considered so you know that the person you’re hiring can actually practice medicine legally.

And as mentioned, the overall purpose of this is to ensure that healthcare professionals meet the necessary standards set by the government and medical institutions – after all, a “medical professional” that is not qualified to provide quality care to your patients is not someone you should pursue.

Credentialing typically includes several steps. First, healthcare providers submit their applications and relevant documentation for review. After this, any of the information you submit also needs to be looked at by primary sources so everything looks okay in terms of accuracy.

There are a few different bodies here, but some of the main ones are medical schools and licensing board certification. Training programs and professional organizations play a role in this too.

Afterwards, it’s generally considered necessary that the physician’s practice history is also examined – just to see if there are any major malpractice claims or disciplinary actions that could be deemed fairly concerning.

Aside from this, peer references aren’t particularly vital but could still be required in order to vouch for the physician’s overall competency and professionalism. And lastly, it’s a fairly common practice that the credentials are monitored every so often so that any changes in the physician’s professional status can be updated.

The Purpose of Physician Credentialing:

     1. Ensuring Patient Safety

All in all, the main reason physician credentialing is so important is for the general safeguarding of the patients, and so only the highest standards of care are being provided.

Once the physician’s credentials have been given the proper due diligence, any potential medical organizations can straightaway spot red flags or any other risks that may jeopardize the overall safety of their patients.

But aside from checking to see if there are any glaring problems, the whole credentialing process basically just confirms that healthcare providers possess all the appropriate skills and training that are necessary in order to deliver competent and reliable care. As far as they’re concerned, this minimizes the risk on their behalf for things like medical errors or malpractice.

     2. Verifying Qualifications and Expertise

As mentioned, credentialing typically serves as the best way of verifying that the physician actually has the expertise necessary to perform their job – things like the right education, have been properly trained, and that they’ve completed the relevant residency programs.

Once their healthcare professionals have been fully screened and vetted, the medical practice owners can be confident that their patients will always be provided with the utmost care and dedication.

How PMN Can Help

For most small medical practice owners, your time is filled up enough by all your other administrative responsibilities, which makes the entire physician credentialing process a fairly time-consuming task – not to mention the complexity of the whole ordeal.

Fortunately, outsourcing the medical billing companies like PMN can be hugely valuable in alleviating some of this burden. While it’s the role of the National Practitioner Data Bank to review the specific medical data of your physicians, companies like PMN can aid you in this journey and most definitely save you some time in the process.

Aside from this, PMN offers a range of additional services, such as medical coding audits and accounts receivable management, to ultimately improve your practice’s bottom line.

Don’t hesitate to get in touch at (949) 215-5055 if you feel your healthcare facility might benefit from PMNs services! Alternatively, you can discuss your medical credentialing process in person at their office in Laguna Hills, Orange County, California!

FAQs

Is There Any Ongoing Training or Education Required After Physician Credentialing?

Though physician credentialing usually focuses more on verifying the initial qualifications of your physicians, it’s absolutely paramount to provide additional education and general training for your physicians so they can develop professionally. This helps with their overall efficiency, but it’s also essential so that your physicians can stay up-to-date with any new medical advancements or code changes.

Who is Responsible For Overseeing Physician Credentialing?

There are actually a few different organizations that look over physician credentialing as it’s a vital process that can’t simply be brushed over. Specifically, some of these institutions include The Joint Commission, the National Committee for Quality Assurance (NCQA), and there are also various individual insurance companies. Collectively, they set all the standards and guidelines so that healthcare providers meet specific criteria.