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5 Lessons Learned: Doctors

on Feb 18, 2017 in Health Care & Medical

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Important Information that You Should Know Regarding Physician Credentialing

The managed care insurance companies, the physician offices, the hospitals and the laboratories all credential the physicians. You must know that credentialing is one act of collecting information regarding the doctor or the medical provider to ascertain their qualifications in practicing medicine according to 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. Know that physician credentialing or medical credentialing is going to verify education, training, licensure, quality and also the general ethical standing of the provider in a 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 would include the licenses, education, board certification, background check, malpractice claims, resume and the detailed work history, privileges, personal preferences, the malpractice insurance and several others.

The information gathered are going to be reviewed by a physician peer-review committee. The committees would actually make recommendations to the professional as well as the standing of the provider in the community. Committees are going to evaluate the ethical behavior of the medical provider.

The insurance companies would include the government-sponsored payers and they will look for the medical credentials of the physician before they would accept the professional into the participating providers. The Medicare and also the Medicaid won’t allow the physicians to have not undergone their credential procedures to bill for their services. Managed care organizations do have such strict physician credentialing process before the provider is listed as participated with the insurance company. A lot of private physician practices would credential the doctors to make sure of quality care delivery.

Know that provider credential is one way to assure the consumers that the medical providers have been reviewed by the peers. Such would provide much higher level of trust and make sure that the provider is licensed as well as certified and hasn’t had the licenses or privileges revoked by another 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.

There are a lot of companies, such as medical practice consultants, specializing in the provider credentials. These companies consult with the different medical facilities and the provider practices to monitor and make sure that the physicians’ credentials are always updated.