The Process That Ensures Your Doctor Is Properly Credentialed

Most physicians tend to place their residency and medical school diplomas on their office walls for all to see because it necessary for their patients to feel that they have come to a reliable doctor and in turn feel relieved that they are in the safe hands of an experienced health professional. Though these diplomas are definitely good signs of accomplishment for the physicians and health practitioners, they don't necessarily guarantee quality. In order to provide this guarantee, a stringent, although not federally required, legal process has been created wherein health organizations and physicians can become accredited through a physician credentialing process.

Doctor credentialing is the formal process of attestation and recognition of the current medical and technical competence as well as performance of a physician by monitoring and evaluating his or her medical or clinical decision-making abilities. Furthermore, physician credentialing verifies medical education, certification, training, license, experience, malpractice, technical abilities, clinical judgment, and if any, adverse clinical occurrences through observation and investigation.

Credentials describe a physician's scope of medical practice and the clinical services that he or she provides. It also ensures that the physician provides services that are of the desired standard. Credentialing physicians is the product of certain objective peer reviews that utilize criteria established through common professional, administrative and legal practices. The criteria are usually directly related to quality of health care and the performance of the concerned physician.

The reviews are expected to be fair, reasonable, arbitrary, performed in good faith, justifiable, have extensive documentation, and must be equally applicable to all. The decisions made regarding physician credentialing should be protected and confidential. In cases where there are adverse decisions being made, certain avenues of appeal and the inclusion of legal hearings are expected to be made available to the physician who is being assessed. There are certain professional standards when credentialing a physician and these include whether or not the physician provides quality and timely medical care, whether there over or under utilization of medical resources, and so on.

Patient referrals to physician specialists or outpatient clinics are generally not considered as important factors in the physician credentialing process. During the process of doctor credentialing in the United States, everything from hospitals, HMO and the state boards of licensure, to the managed care entities and different organizations have to address two main issues. One issue mainly deals with factors that confirm the physician's background information, like graduation, residency, and whether or not the certification is valid. The second issue deals with the physician's special request for the rights to provide care for a select spectrum of patients. Yes, a lot of healthcare facilities and even physicians today are finding themselves entangled in malpractice suits for incompetence or for hiring incompetent physicians. Thus certain legal processes have been designed for effective physician credentialing.

Privacy Policy