Healthcare Credentialing a Guide for new Graduates
You've completed your Residency training; have chosen an office location and need to get on staff at the nearby hospitals so you can care for your patients. So, what's next?
The Application: You need to contact the Medical Staff Office, or in some facilities, Administration, to request an application for Medical Staff Membership and Clinical Privileges. Once you receive the application, review it carefully and gather all the supporting documentation it requests. Then, complete the application in its entirety, accurately and legibly. Attach your supporting documentation and return your packet to the Medical Staff Office as soon as you can. Supporting documentation would include: your current CV, a passport-sized photograph (some require this to be notarized) copies of licenses, certifications, procedure log, malpractice insurance certificate, and any continuing medicaleducation over the past 2-4 years.
TIP: If you have any time-gaps between your medical education and the present time, or any past, present or pending claims, you will be requested to explain these in writing. You can compose a memo addressing these issues ahead of time and include it with your application.This is the best thing you can do, as the applicant, to assist in the prompt completion of the credentialing process. Omissions and legibility are the two major causes of processing delay in the credentialing world. Keep in mind that your application introduces you to the Medical Staff of your chosen hospital, and is often their first impression of the type of practitioner they think you will be. A neat, accurate and complete application brings joy to the Medical Staff Office credentialing staff and leaves a favorable impression on those practitioners who will be reviewing your file for approval recommendation.
TIP: Make sure your CV and your application tell the same story.
What is Reviewed: The application for membership and clinical privileges at any facility will request the following: Demographics, Education, Training, Licenses (all states), Certifications, Affiliations (hospitals, surgery centers, clinics, etc.), Employment (previous and current), Malpractice Insurance (do you have it, have you had it, are there any claims?), Peer References (they cannot be family or direct partners or associates), Continuing Medical Education (usually for at least the previous 2-4 years) and a listing of procedures you have performed over the past few years (a procedure log). This provides the Medical Staff leadership with the information needed to determine competency for the privileges you have requested.
The Credentialing Staff: Once the Medical Staff Office receives your application, it is forwarded to a credentialing specialist for processing. The specialist is charged with verifying everything on your application according to regulatory standards and the Bylaws, Rules & Regulations of the Medical Staff leadership of the hospital. This involves contacting those schools, licensing agencies, affiliations, peer references and insurance companies listed on your application.
TIP: Include phone and fax numbers and email addresses for your affiliations, peer references and insurance companies.
The Medical Staff Leadership: Once your application has been verified and considered complete, it will be forwarded to the Medical Staff Leadership for review and recommendation for approval. This may include a personal interview with the Chief of Staff, his/her designee or the Credentials or Medical Executive Committees. Depending on the process of the hospital, they may send you a letter inviting you to attend a meeting or participate in a telephone interview. Once this is completed, the Medical Executive Committee will review your application and the verifications received, and submit their recommendation to the Governing Board of the hospital.
Approval: The Governing Board will then review the Medical Executive Committee's (MEC) recommendation, which we will assume for this article is approval, and will then approve your request for Medical Staff Membership and/or Clinical Privileges. You should receive a formal letter outlining your appointment period and the privileges that you have been granted.
NOTE: Appointment periods are not longer than two (2) years and you will need to complete a reappointment application to maintain your membership and/or privileges every two (2) years. All new information is verified and reviewed in the same manner explained above.
NOTE: Medical Staff membership and clinical privileges are two different things. You can have clinical privileges at a hospital without being a member of the medical staff (i.e., locum tenens, emergency privileges) and you can be a member of the medical staff without clinical privileges (emeritus, honorary).
Why we do it: To comply with regulatory standards and to keep the "care" in healthcare. The credentialing process is the first layer of protection for both patients and practitioners, from those individuals that are not appropriate to practice within their requested setting.
