Health care facilities of all types, from hospitals to surgical centers, nursing homes or hospice programs, require credentialing for staff providers. A wide array of information with supporting documentation is usually requested. The credentialing process can be quite burdensome but the information requested and the processes used by various organizations follow a fairly typical pattern.
Build a Plan and Process to Make it Easier
Planning is vital. Make file maintenance for credentialing documentation part of the routine. Keep copies of all pertinent data up-to-date in a centralized location. Create checklists (or use our Facility Credentialing Checklist) of all pertinent data
Credentialing applications usually require a large amount of background information, including complete education history with diplomas, work history, a current CV, board certification information including type and dates with supporting certificates, state licensure information with a copy of the license, malpractice liability coverage and certificate, state and federal controlled substance licenses and certificates, NPI, among other items. Each physician and the practice as a whole need an initial checklist and a yearly recredentialing checklist. As appropriate documentation arrives, put a scanned copy into each provider’s yearly credentialing file.
Build reminders for all submission dates into your calendar system for checking status of the National Provider Information (NPI), state medical license, maintenance of board certification status, malpractice liability coverage, Office of Inspector General (OIG) sanctions exclusion database, and the National Practitioner Data Bank. Keep a screenshot of the search results as each is checked. For additional security, place these reminders on the calendar for multiple staff members.
Background Checks
A background check is performed by many institutions and often occurs behind the scenes and without the applicant’s knowledge. Background checks typically include criminal background check. Employment, training, and education history will be confirmed as will the status of any privileges listed on the application. Most organizations also verify Medicare sanction information, through the OIG sanctions exclusion database, and check the National Practitioner Data Bank on closed and settled claims history. Any history of a malpractice claim, suit, or prior suspension of privileges will be scrutinized. It is best to fully disclose these issues at the outset with a well written explanation of all circumstances.
References
Most facilities require between two and five references from physicians with many stipulations regulating who can serve as a reference. Typically, references must come from a physician in the same specialty who is not related by blood or marriage and is not a member of the same practice.
Conclusion
The process is onerous. It is also vital and affects the ability of your practice to care for patients and partner with other health care organizations. Surprises in this world are seldom good. Take it seriously and stay ahead of the game.
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