The process of Medical Credentialing.

Hello Everyone, I am Ahmad Rizwan, Credentialing Specialist for USA Healthcare Providers. Here are some details for the pre-process of Medical Credentialing. If you need any help for Medical Billing & Coding services feel free to contact me via email. For more updates, subscribe this newsletter.

The process of Medical Credentialing:

Healthcare facilities should have staffing policies that govern administrative processes that ensure that healthcare professionals provide competent and safe care.

All healthcare professionals should understand that practicing clinical medicine is a privilege and goes hand in hand with first certification. After an individual is credentialed, the next step is to address practice privileges, which depend on an evaluation of the provider's clinical qualifications, training, and overall performance. For Credentialing user should address the following:

• The pre-application process for screening whether a healthcare worker meets the basic criteria to work in a hospital
• Establish reasons for rejection of applications after the pre-application process
• Establish a process where a rejected health professional can reapply after an initial rejection
• Have a process for rapid authorization for positions, emergency personnel and short-term employment
• Introduce measures to restrict the practice of medicine for those health professionals who do not follow the guidelines or the level of care is not satisfactory
• How to Grant Temporary Privileges: Sometimes an outside physician or surgical specialist may be asked to offer advice or perform a life-saving procedure.
• Granting emergency privileges to healthcare workers in times of disaster (for example, during a flood or earthquake, there may be an urgent need to have staff to care for patients).
• Establish a code of conduct for a healthcare professional who obtains accreditation and penalties for non-compliance
• Granting Privileges with Shadowing: Physicians and surgeons from countries outside the United States may often have different backgrounds. These healthcare workers may need shadowing or protection for several weeks or months before full privileges are granted. For example, many hospitals have a process of proctoring surgeons in cardiac surgery to ensure they know what they are doing.

Who requires credentialing?

In general, any licensed independent health practitioner who is permitted by law and regulated by a licensing organization to provide services and care without supervision or direction within the scope of the individual's license must be credentialed. While each state has unique laws regarding the practice of medicine, simply having a license to practice medicine does not mean that a person can provide any medical service they want. For example, an advanced practice nurse cannot independently start prescribing medication or a family physician cannot start setting up central lines. Even independent nurses must follow specific rules and in some states work under a physician. Mere licensure does not mean that health professionals are free to perform all types of clinical services. Each healthcare professional has a role to play and, once licensed, can only perform a function for which they are privileged.

Privilege is the process by which a healthcare professional is authorized to perform a specific set of patient care services based on an evaluation of an individual's credentials and performance. A "privilege" is defined as a benefit that is not available to all healthcare professionals.