Medical Credentialing; A Light at the End of Physician’s Tunnel
A physician credentialing process is a long process to verify the credibility and competence of a physician. Partnership with certain insurance organizations requires a full background check on the physician applying.
Its Importance and Purpose in Healthcare
If a patient seeks matters of health, it is automatically assumed that he wants to get it from one of the best there is. A physician takes pride in his accomplishments in his career and one way of highlighting this to the world is to be certified through a credentialing process. After all, no one, not even the physician himself, would want to jeopardize his health over someone with a questionable medical background.
The Physician credentialing process is a meticulous, tedious (taking at least weeks to several months), and very accurate process that entails intricate investigation of a practitioner’s academic and professional background. He should start the credentialing process long before he has any plans of seeing patients. Though it is very complex and time-consuming, once a physician is certified a patient can rest his doubts on the quality of healthcare that he will receive. Mostly, Health insurance companies are the ones behind this process to make sure the patient will receive the correct diagnosis and treatment and proper claims can be received on his end.
It is greatly advised for a physician to undergo this process and he is, in fact, discouraged to render his services if he has not yet properly undergone the credentialing process. It is also illegal for one provider to bill a patient under the name of another provider.
The Physician Credentialing Process as a Cycle
A physician should begin this process as early as his entry into medical school and will continue as he progresses in his career. This process includes his attended medical institution, training, board certifications, involvement in organizations, and any relevant experiences that can prove his competency as a practitioner. Once a physician is certified, there will be another cycle of this in 2-3 years to validate again his competency to be in the organization and to assess his skills to handle new clients.
Preparations of a Physician for the Process
If a physician wishes to undergo a credentialing process, he must fill out a form where he will declare all of the information relative to his practice. This may take some time to accomplish since it is a very inquisitive process and leaving blanks and failure to show consistency on it may obstruct the good flow of the entire process.
The physician should prepare at least the following prior to his application:
- National Provider Identification
- Current Driver’s License
- Social Security ID
- Tax ID number
- State licensing
- Education, Internship and Residency certificates
- Specialty and Subspecialty Certificates
- Board Certificates
- Drug Enforcement Agency records
- Medical group affiliations
- Continuing Medical Education documents
- Malpractice claims
- Employment History including gap year
- Hospital affiliations
Trials of the Credentialing Process
Incomplete documents, incompletely answered parts, unpaid fees, and incongruent data may hinder the physician’s credential process and may even require a physician to start again. This now becomes a burden to both the physician and the organization which will later on cause a delay in onboarding of new physicians and therefore can limit the pool of physicians available to the patients and can cause healthcare compromise.
An erroneous credentialing process on the other hand, could impose risk on the reputation of the organization involved and even on the physician himself. Though time-consuming, a slow but accurate process can greatly avoid legal events in the future sparing both the careers and reputation of both partners from trouble.
Simple Tips on Getting it Done
A physician as early as his medicine career should be keen on the requirements and documentation of his training. This includes diplomas, certificates, registrations, and even a clean, morally upright track record. The physician should be an embodiment of professionalism which will represent not only himself but the partner organization that he will be in partnership with in the future. Fill out the form completely with all the information needed and make sure there are no inconsistencies in it. Explain why some of the data is not available for answering if possible. Verified information is always a key to a successful physician credentialing process which is why in every physician’s milestone reached, a valid certification should always be obtained.
The physician should also, in his career-building years, be mindful of some ethical and moral issues he may face and try his best to avoid them at all costs.
Physician Credentialing – Is It Worth It?
The answer to this will always be YES. Government insurance organizations such as Medicare and Medicaid and other insurance companies deliver healthcare coverage to the public throughdoctors who are confident that they will be paid properly. Medical billing is also easier once a physician has been a certified partner of the insurance companies. It may only be hard at first but the entire process equates to medical credibility improvement once done.
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