The Complex Physician Credentialing Process

Physician credentialing is the procedure for evaluating practice history and the qualifications of a doctor prior to acceptance of hospital privileges, employment, insurance plan approval, or licensure. There are few agencies that keep credentialing documents, thus, the process is burdensome and time consuming with few shortcuts for doctors who are submitting qualifications to multiple agencies.

Credentialing calls for a formal application by a doctor that is then verified against information from the American Board of Medical Specialties or The National Practitioner Data Bank. Any state where the doctor has an active license is contacted to identify any practice problems. Training and education are checked through direct contact with hospital programs and schools, and registration with the Drug Enforcement Agency and Medicare/Medicaid is usually confirmed. Board certification is also verified. Other essential information includes personal information like credit history or bankruptcy which could reveal a malpractice claim settled out of pocket and unreported to the data bank. Lapses in employment must be explained and are also thoroughly investigated.

Credentialing usually takes about 90 days, however it's best to allow at least 150 days to complete the procedure. Any disparities including missing, outdated, or incomplete information can delay the process. The most common areas that cause delay are verification of current work status, work history, malpractice coverage, hospital privileges, and attestations.

In 1906, the American Medical Association established Physician Masterfile to keep membership information including education, certifications, and training. This information is available to agencies and organizations that verify physician credentials. Background information can be certified by the Federation of State Medical Boards for a fee, paid by the physician.

Many agencies accomplish the credentialing procedure on a physician's behalf for a fee, and these agencies are in high demand because of the need created by the cumbersome credentialing procedure.

Healthcare facilities could be held liable in malpractice suits if they allow incompetent physicians on staff, hence before determining who to hire, as much information as possible is verified.

Have you ever experienced a rise in the credentialing requirements?  Do you have any solutions to this cumbersomeprocess?