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When you think about credentialing and privileging you might be reminded of the chicken and the egg, which comes first? Both are necessary for medical providers to practice, but one can’t really happen without the other. 

Credentialing is like asking your catering chef to show you his culinary school diploma. Privileging is asking him to julienne a carrot. Both are important to make sure you have a qualified and skilled chef.

Similarly, healthcare organizations want to make sure they have qualified and skilled medical professionals treating their patients. They are responsible for verifying the qualifications of practitioners to make sure they are accurate. By ensuring that healthcare providers have the proper license and documentation to provide treatment, they are safeguarding the health and wellbeing of their patients as well as protecting the facility from potential liabilities. This process is considered credentialing.

Privileging requires credentialing to be performed and requires the provider to, essentially, prove they are capable of the specific skills they intend to perform. Privileging ensures that individuals act within the scope of their practice and provide competent patient care in line with their role at the facility.

 

Credentialing Basics

 

Most credentialing revolves around confirming the education, accolades, and achievements of a healthcare professional. These may include:

  • Educational Requirements: Including which schools they attended and what level of education was completed. Degrees are an essential part of confirming the education of a provider.
  • Licensing Requirements: Ensuring that the healthcare professional has the proper licensing to practice medicine.
  • Postgraduate Accomplishments: This includes internships and other work performed following the completion of their education.
  • Certificates and Recognitions: Any recognitions they received and their participation in accredited training programs.

*Primary Source Verification (PSV) – Many large accrediting bodies such as The Joint Commission require PSV which means the healthcare organization is required to reach out to the primary source of the document such as the school where the provider received their diploma.

Credentialing is an essential part of the healthcare industry. Not only does it ensure a facility’s provider has the education and skills to perform in their role, but it also protects patients from discrepancies in care, safeguarding their health and wellbeing.

 

Privileging Basics

 

Although related to credentialing in purpose, privileging is, in essence, the act of authorizing a healthcare provider to perform certain tasks and treat patients within the scope of their expertise. 

Privileging is an application-based undertaking that relies on the provider to submit information to prove their ability to execute the duties they wish to perform at the facility. Remember, just because a chef went to culinary school, doesn’t mean he knows how to properly season a chicken. 

Another key difference in privileging is the responsibility falls on the provider whereas, with credentialing, the responsibility belongs to the healthcare organization.

 

Credentialing Requirements

 

The verification process for credentialing can be long and laborious. Some of the items needed per provider include: 

  • Educational history and transcripts
  • Current medical license
  • DEA registration
  • Board certification if applicable
  • Work history
  • Evidence of continual malpractice coverage.
  • Personal immunization records
  • Professional and personal references
  • CAQH enrollment
  • OIG/SAM Exclusion Check

Credentialing is most often done by the administrators at a healthcare facility. Upon completion, the information is provided to a governing board within the institution to give the final approval for the provider to begin practicing. Credentialing is also required for provider enrollments which is how healthcare organizations get reimbursed by insurance companies. 

Additionally, re-credentialing is also needed as credentials typically expire in two-year increments. With this in mind, a healthcare facility should have policies and procedures in place to streamline the credentialing process for new providers as well as have a defined plan in place to track credentialing for all current healthcare professionals working at the facility. 

 

Privileging Requirements

 

Privileging requirements can differ depending on the healthcare setting the provider is working in. Yet, in all cases, privileging records must be kept to ensure each healthcare provider is providing optimal care within the scope of their professional abilities. Privileging will require numerous documents from the provider which takes time and effort to compile as well as some effort from healthcare administrators to store and easily access the documents. 

As with credentialing, privileging is also an ongoing process that requires the initial privileging of a healthcare provider and continued evaluation of their performance on the job. Processes should be put in place to provide real-world, objective evidence as to the provider’s level of effectiveness in performing their defined duties. 

 

Credentialing and Privileging: Necessary Components to Providing Patient Care

 

Both credentialing and privileging are essential for maintaining compliance with local, state, federal, and third-party requirements, as well as tools to ensure your patients are receiving the best care your facility can provide.

At MedTrainer, we understand that the administration of a healthcare facility is no easy task. Both credentialing and privileging create additional work that can sometimes be frustrating and is often time-consuming. That’s why MedTrainer’s all-in-one software is a great way to streamline your internal processes and reduce the time you spend credentialing, privileging, and training your staff. Contact us today to learn more about MedTrainer and change the way you manage the staff at your facility!