Credentialing & Privileging

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Hospitals have a legal duty to evaluate the competency of physicians who administer health care services to their patients.  In efforts to ensure that patients receive competent medical attention, physicians are required to undergo a process, which is known as credentialing.  Credentialing is the practice by which hospitals evaluate and verify the qualifications of their healthcare providers to ensure that each individual practitioner possess the necessary qualifications to provide medical services to patients.  Once a practitioner is credentialed, the hospital will take further steps to assess the practitioner’s competence in a specific area of patient care, through a process known as privileging.

Credentialing is founded on the principle that hospitals are responsible for ensuring the highest quality of care possible for their patients.  In efforts to accomplish this goal, medical care facilities take steps to verify their health care provider’s proficiency through the collection, verification and evaluation of data relevant to the practitioner’s professional performance.  After the practitioner has met the credentialing requirements for the hospital, the practitioners expertise in a specific practice is further evaluated, this process is known as privileging.  The process of credentialing and privileging occurs after a physician has already met the state’s licensure requirements.

In most hospitals and health care facilities, physician credentialing takes place in two phases.  During this initial phase the hospital verifies that the physician has completed medical training, is licensed to practice in the state where care is being administered, and has no pending medical violations on record.

However some hospitals require that their physicians undergo a second credentialing process, known as periodic credentialing, which allows hospitals to reassess the competency of their physicians.  During this phase, hospitals have the opportunity to reevaluate a physicians evolving medical history with the hospital.

After the credentialing process is completed, the hospital will assess the physician’s competency in a certain medical practice area, like surgery or cardiology.  Once the hospital has evaluated both the physician’s medical practice history and the physician’s competency in their intended field of practice, the physician is both credentialed and privileged.

CMS Issues Credentailing and Privileging Memo to State Survey Directors

The Survey and Certification Group of the Centers for Medicare and Medicaid Services (CMS) sent a memorandum to the State Survey Agency Directors with information regarding the implementation of the July 5th CMS rule on credentialing and privileging for telehealth practitioners in hospitals and critical access hospitals.

Click Here for a copy of the CMS Memorandum on Credentialing and Privileging of Telehealth Practitioners.

CMS Final Rule on Credentialing and Privileging Telehealth Practitioners

The Centers for Medicare and Medicaid Services’ final rule on credentialing and privileging requirements for telehealth practitioners is effective on July 5, 2011.  This rule establishes a process for originating site hospitals (location of the patient) to rely on the credentialing and privileging decisions of the distant site hospital (location of the specialist) for telehealth practitioners.

Click here for a transcription of the July CTeL Brown Bag Webinar, titled, “CMS Final Rule:  Credentialing and Privileging for Telehealth Providers.

Click Here:  Sample Credentialing and Privileging Written Agreement–Hospital to Hospital

Click Here:  Sample Credentialing and Privileging Written Agreement–Hospital to Telemedicine Entity

Click Here:  CTeL’s Special Report on CMS’s final rule on Credentialing and Privileging of Telehealth Practitioners

Click Here:  Check List:  482.22. Conditions of Participation–Medical Staff   (with Final Rule Language)

Click Here:  Check List:  482.12. Conditions of Participation–Governing Body    (with Final Rule Language)

Click Here:  Check List:  485.641. Conditions of Participation–Quality Assurance Review (with Final Rule Language)

Click Here:  Check List:  485.616. Conditions of Participation–Critical Access Hospitals – Agreements (with Final Rule Language)

Click Here:  Check List:  485.635. Conditions of Participation–Critical Access Hospitals – Provision of Services  (with Final Rule Language)

CMS Conditions of Participation — Hospitals and Critical Access Hospitals  (with Final Rule Language)