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Credential Progress In The Healthcare Organization

659 words - 3 pages

Credentialing is used by healthcare organizations and health plans to verify education, training, and experience of medical staff. When a physician or licensed independent practitioner (LIP) is credentialed they become affiliated with that organization and are members of the medical staff or health care network. The organization’s owner or governing board is held legally accountable for the quality of care and staff conduct and the medical staff is accountable to the governing board for the quality of care they provide. The credentialing process determines if medical staff is competent and capable to treat and care for patients before allowing membership or network affiliation.
The medical staff committee is in charge of conducting competency evaluations using established governing board criteria - character, competence, training, experience, and judgment. Competency evaluations are completed according to medical staff bylaws and include background checks, privilege delineation, and confirm level of competency. A competency evaluation is required for new applicants, reappointment (every 2 yrs.) and medical staff privilege change requests. New applicants present the organization with a formal application request for membership- active, courtesy, consulting or allied health. A request can be for membership only, core privileges, or catagorized privileges. Along with the application the following information is required: current licensure, DEA certificate, liability insurance, details on education, training, and experience, board certification/re-certification, medical society memberships, medical litigation – filed, pending, or settled, unfavorable peer reviews, felony conviction and voluntary or involuntary privilege reductions, resignations, suspensions, denials, or changes. The medical staff coordinator or credentials committee verifies the information with sources and accesses the National Practioner Data Bank (NPDB), a federal requirement, to search for termination, suspension or revocation of clinical privileges, malpractice awards, and actions taken by state, federal and medical societies against the applicant. The application is then reviewed by the Medical Director, Medical Staff Executive Committee, and the Peer Review Committee. The Peer Review Committee makes the recommendation to the board for deferral - for pending information,...

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