Credentialing is defined as the act of verifying a clinical practitioner is who they say they are, obtained the education and training they say they received, and through obtaining confirmation of the presence or absence of current or historical adverse actions against licensure, clinical privileges, board certification, and professional society affiliations or other professional practice aspects.
While we consider credentialing to be a fairly modern concept and process, the act of credentialing clinical practitioners began as far back as the year 1000 BC, as a mechanism to protect society from ill-trained, self-identified physicians, establishing the first known process to assess the education and training of a physician. 1
In the year 2018, credentialing still matters. In fact, the act of credentialing a clinical practitioner remains one of the most critically-important processes to protect our communities and the general public from clinical impostors. It also serves as an administrative process to assure the delivery of quality care and the mitigation of organizational risk.
The process of credentialing has frequently been referred to as a ‘non-revenue generating hassle; a costly process of pushing piles of paper through a sausage-making machine’. Yet, the reality is that credentialing is required by federal regulation, as well as all health care accreditation bodies. Hospitals would be shut down without performing it; insurance payers could not offer various lines of business and products without performing it, and the same is true for ambulatory surgery centers, physician organizations, and a variety of other health care delivery settings.
Beyond federal regulations and accreditation standards, credentialing matters because it is the right thing to do for our society. Not only must credentialing be done, it must be done well, and with precision, accuracy, and due diligence. A faulty or non-compliant credentialing process could be as bad as no credentialing process at all, resulting in revocation of Medicare participation, sanctions, loss of accreditation and mounting litigation.
There can be no mistake — credentialing matters. If your organization is backlogged, understaffed, or challenged in executing an efficient, quality high performing credentialing program, PCVS can help. PCVS is a dually-assessed CVO by the National Committee on Quality Assurance (NCQA) and the Utilization Review Accreditation Commission (URAC), that has been serving Michigan and national clients for twenty years. Contact us today to learn how we can best assist with your ‘credentialing matters.’
1 https://acphospitalist.org/archives/2009/05/newman.htm