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Credentialing In Health Care

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The credentialing process can be divided into two smaller components which entail initial credentialing and the credentialing of medical practitioners. al practitioners. To make sure that qualified practitioners are providing care at the institution in question, the process is slightly different for these two separate entities. Initial credentialing requires primary source verification of education and and board certification as well as looking at past employment records and competencies in various professional areas. “Primary source is defined as either the source of the information being verified, such as a license board, or as a secondary data repository that has been approved to act as a primary source by the relevant auditing organization”…show more content…
Most importantly, the practitioner's performance file is reviewed to make sure that they continue to practice and provide quality care according to the standards of the hospital. Most hospitals have a peer review process of some sort and outcomes are reviewed and scored and the results placed in the providers filed. These files are brought together and made part of the recredentialing process. Once all the information is been correlated, it is review by the appropriate chairs of departments, that have specific knowledge of the provider's care history as well as an better understanding of the specific specialty under which the provider is being credentialed. The file is then sent on and evaluated by the credentialing committee which is a subcommittee of the medical executive committee. The credentialing committee reviews the findings to make sure that there are no cause for concern and that the provider should continue to provide care in their field especially. These findings and recommendations for recredentialing or initial credentialing are then passed on to the medical executive committee and ultimately the Board of…show more content…
Length of stays are also evaluated, as length of stays often speak to whether providers are following evidence based medicine and thus providing quality care.Besides looking at volumes the credentialing committee will need to look at performance including morbidities and mortalities. These numbers and other quality indicators should be review to see if providers are performing at with national averages. With the the onset of value based purchasing, there is now much data such as HCAHPS which can and should be evaluated which allows providers to be compared to other local physicians as well as national averages. Patient complaints and disciplinary action which have also be placed in provider's files must be reviewed as part of the credentialing process. This allows institutions to see if there is some type of trend that needs to be corrected or if there's a reason for adjustment to providers privileges. Often completion of the medical records is also considered as well as part of this process. This speaks to providers attention to detail and compliance with other hospital rules and regulations. Continued noncompliance can be cause for disciplinary action, re-education, or may require corrective
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