PCVS Press Room

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Credentialing: A Quality Function

Recently, a number of news reports regarding individuals posing as physicians and other clinicians have sent ripples of shock and panic throughout our communities. In many cases, patients on the receiving end of their unqualified ‘care’ endured physical and psychological harm. It’s alarming to know such individuals continue to find a way to betray the public trust. How do these imposters slip through the cracks?

The answer is simple. They were not subjected to a rigorous, thorough credentials investigation. A comprehensive credentials investigation process would have revealed these individuals were not who they claimed to be, and did not have the clinical education, training and qualifications they said they had. Most importantly, patients would not have been harmed at the hands of such unqualified imposters.

Credentialing is a quality function. First and foremost, credentialing serves as a public safety mechanism to protect patients and provide assurance of the delivery of qualified care. Credentialing fulfills federal and state regulatory requirements, accreditation standards and organizational quality policies. Credentialing, simply, is the act of fully vetting an individual claiming to be a physician, nurse or other type of clinical caregiver, before they ever lay a hand on a patient.

A comprehensive, thorough credentialing program verifies, directly with primary issuing sources, items such as successful completion of medical/clinical education, training, board certification, clinical competency through peer references, licensure, professional liability insurance, professional liability claims history, professional sanctions (Medicare/Medicaid), adverse clinical privileging actions, hospital affiliations, among other items. Moreover, many of the verifications are subject to strict timelines, which allows medical staff or organizational leaders to make credentialing decisions based on current provider-applicant information.

Not all credentialing programs are alike. A select few Credentials Verification Organizations (CVOs) nationwide, like Professional Credential Verification Service, Inc. (PCVS), are certified by the National Committee for Quality Assurance (NCQA) and accredited by the Utilization Review Accreditation Commission (URAC), and, as applicable, apply The Joint Commission (JCAHO), Health Care Facilities Accreditation Program (HFAP), among other credentialing accreditation standards, to their overarching CVO program. That is, PCVS operates within the highest industry standards for credentialing activities, providing its clients and our communities with timely, detailed and quality information on every provider-applicant.

Credentialing is a quality function that assures patients safety. Is your organization doing all it can to keep clinical imposters from compromising patient safety and trust?