Are you trying to figure out what physician credentialing is in the healthcare profession? Read this article to learn everything you need to know.
84.3% of American adults had contact with a health care professional at least once in the year 2018. The role of American physicians will become increasingly important in the management of emerging health care needs. This is especially so with the rise in the number of the aged and the aging.
But are our physicians equipped well enough to manage these emerging health care needs?
Various mechanisms exist globally to ascertain physicians’ qualifications. The venting occurs before they can be admissible to practice. In the United States, physician credentialing is an essential pre-certification process for all doctors.
Are you wondering what physician credentialing is all about? This article has all the answers.
What Is Physician Credentialing?
Not everybody can practice as a medical doctor. Agencies exist in the U.S. to oversee physician credentialing. This agency takes up specific roles in the course of validating a doctor’s qualification.
Credentialing entails the procedure used to organize and verify a GPs’ professional records. The process seeks to validate a physicians’ identity. It also assesses a physician’s work experience and other licensing verification.
Such steps are critical in the course of protecting patients from quack physicians. Any doctor seeking to practice in a hospital must undergo a process of credentialing.
Such agencies include the National Provider Identifier. Physicians must prove the validity of their professional certifications before qualifying to practice.
There are three key processes that define credentialing.
- Provider Credentialing
This phase involves the process of verifying physician skill sets. You may need to research the specific State licensing requirements within your area of practice. This would serve to ensure compliance. Further, you may also need to consider DEA licensing as part of the accreditation procedure.
Training and education are critical elements in the provider credentialing process. Physicians need to certify that they have reached the set levels of education. They also need to prove that they attained the requisite pre-practice training per the set certification standards.
This process is vital in ensuring that there’s a thorough vetting of general practitioners. The vetting process tests the theoretical and practical application of medical practice.
- Provider Enrollment
The next phase involves provider enrollment. The Affordable Care Act has, over time, increased physician credentialing stipulations. This step is in a bid to deal with the cases of fraud and abuse.
Physicians need to fulfill new credentialing requirements for Medicaid and Medicare. The stipulations include periodic attestation.
All physicians seeking credentialing must provide a list of verification. Such documentation shows proof of partnership with insurance carriers. This must occur if such physicians want to be eligible for reimbursable expenses.
Doctors seeking physician credentialing must also provide a malpractice insurance certificate. Such requirements seek to ensure that the patient is covered in case of unforeseen outcomes.
- Privileging
After certifying provider enrollment and provider credentialing procedures, the next phase involves privileging. Physicians must prove beyond any reasonable doubt of their capacity to practice.
Once this is ascertained, the last step then involves approval. With the attainment of such privileges, physicians may now qualify for hospital affiliation. You may also undertake other related general practitioner functions.
Key Takeaways When Undertaking the Process of Physician Credentialing
There are essential factors you need to consider during the credentialing process. The time frame is one critical factor.
Time
A typical credentialing process may take between 90 to 150 days. The timing depends on your anticipated area of practice. It would be best if you considered giving yourself adequate time to undertake the process.
But you can reduce the waiting period during credentialing significantly with reliable career management & continuing education platform. You can learn more about credentialing here as you kick start your career as a physician.
Accurately Filling out the Paperwork
The physician credentialing procedure may take longer than you would ordinarily expect. This is more reason why you need to fill out the paperwork accurately. Filling the paperwork with errors may force you to undergo the process all over again.
Ensure that you undergo a run-through of the paperwork. Such pre-planning should be before filling in anything. It would be best if you used this chance to confirm that you have every detail required in the paperwork.
Critical information, such as physician’s works history and current work status matters the most. Don’t forget your attestation.
You may encounter significant backlash if your application has inaccuracies and discrepancies. It would be best if you also considered informing your references of your intention to include then in your addendum. Such a move ensures that your references respond promptly and also provide information that builds your case.
Consider a Checklist
Some of the critical information to include in the credentialing packet includes your Taxpayer Identification Number (TIN). You should also include the National Provider Identifier –2. Don’t forget to include your phone and fax number in case of urgent communication.
You should then ensure that you complete the W9 for your practice. Finally, you also need to file a list of all the insurance providers you wish to partner with as a physician.
Ensure That You Stay Current
One of the main aspects that may cause you problems during the physician credentialing process is the failure to remain current. It would help if you considered keeping your profile current.
Agencies such as the Coalition for Affordable Quality Healthcare can ensure that the procedure is simplified. If your credentials are current, you may have a more comfortable and faster process.
Know Your State Laws
As the number of individuals seeking professional credentialing increases, States have also become stringent in their credentialing standards. Each state has different procedures and stipulations guiding its accreditation process. If you intend to change States, you need to take time out and learn the underlying systems in such jurisdictions.
Physician Credentialing Is Not Every Doctors’ Cup of Tea, But It’s Worth the Hassle
You’ll experience frustrations in the course of undertaking the physician credentialing process. Nevertheless, despite this procedure being time-consuming, it’s indispensable. Some of the critical benefits of physician credentialing include hassle-free insurance reimbursement and the barring of quack medics from practice.
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