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Medical credentialing is a process involving two parts; privileging and credentialing. Credentialing verifies the competency-based on licensing, work experience, training, and education. Privileging means approval grants for healthcare providers. Healthcare providers must get approval before performing certain actions or procedures. In this post, you will learn everything important about credentialing.

How Does Medical Credentialing Works?

It is a standard process that tries to maintain the quality standards in the healthcare profession for patients’ benefit. The medical credentialing process involves contacting primary sources to verify the qualifications of the healthcare provider.

The CVO (credentialing authority) contacts universities where providers:

  • Completed their medicine degree
  • Had training
  • Did residency

The authority does it to confirm the credentials of healthcare providers. They also contact licensing agencies and certification boards to verify specialty certificates and licenses. Employers and hospitals can provide work history confirmation.

For every single new hire, credentialing is significant. However, it is always essential to perform credentialing regularly.

Advantages of Credentialing

This process holds immense significance in the healthcare industry by providing quality assurance, benefiting every single party. With medical credentialing, clinics and hospitals are rest assured that new hires will provide high standard care. Insurance companies always prefer professionals with adequate proficiency in medical practice.

Credentialing is also beneficial for practitioners because they can increase the patient number after receiving privileges from the insurance company. Ultimately, patients receive the utmost benefit; knowing that they are receiving rigorous healthcare services.

Medical credentialing ensures that the healthcare provider will provide high-quality care to patients. It also ensures that the costs are down and medical errors are the least. This system ensures that every party involved gets benefits.

Who Require Medical Credentials?

Various healthcare providers require medical credentials. Those include physicians, optometrists, ophthalmologists, and podiatrists. The system of credentialing is comprehensive. To maintain a high standard, it covers every single aspect of healthcare-related services.

What Facilities Require Credentialing?

Apart from practitioners, facilities themselves also have to maintain competence and care standards. Various types of services and facilities need to acquire appropriate credentials to work as healthcare service providers. Those include:

  • Ambulances
  • Hospice care
  • Dialysis
  • Medical equipment
  • Home Health and In-Home Care
  • Laboratories and collection sites (radiology/diagnostic imaging, prosthetics/orthotics, lithotripsy)
  • Urgent Care Centers

Apart from the above-listed facilities, a few others may also require medical credentialing.

How Much Credentialing Costs?

The cost of credentialing is different for different specialties, facilities, and CVOs. Usually, the application charges of $200-$300 aren’t extraordinary. Facilities often will provide partial or full reimbursements on the successful credentialing completion. After the primary credentialing, it is essential to have periodic re-credentialing. Usually, CVOs provide re-credentialing at discounts rates.

Can Providers Operate During Medical Credentialing Process?

No, healthcare providers have to wait till the completion of their credentialing process. They can start their work after the approval. It ensures that patients keep receiving proper services from healthcare professionals with proper experience, training, and education. If a facility violates this rule, it will put itself at a big legal risk. They might lose their credentials as healthcare provider.

You May Also Read: HIPAA Medical Billing – A Perfect Technique for Secure Online Billing

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