4 things medical staff leaders need to know about credentialing

This week, CRC Daily covers medical staff leadership and governance. When new medical staff leaders step into their new roles, one of the many duties they take on is playing a part in the credentialing process. Although a physician has been on your medical staff and has gone through the credentialing process as an applicant, it is a mistake to assume that he or she understands the behind-the-scenes workings of credentialing. The following are four credentialing truths that new medical staff leaders need to know:

• The difference between credentialing and privileging. Many people extend the term "credentialing" to privileging activities; however, the two processes are distinct. Credentials relate to practitioners' qualifications to practice medicine (e.g., education and licensure) as a prerequisite for consideration of granting clinical privileges. Privileges are what practitioners can actually do at the organization based on their training and experience. Not all practitioners who are credentialed are privileged. For example, a practitioner may wish to remain affiliated with a hospital as a member of the medical staff, but no longer provides clinical care at the hospital and therefore does not need privileges.
• The importance of having every piece of paper in the file. Dianna Ruppel, CPMSM, CPCS, manager of medical staff services at NuHealth—Nassau University Medical Center in East Meadow, New York, encourages the department chairs at her facility to contact other facilities' department chairs who owe affiliation letters on an applicant. Ideally, this will prompt a response from one colleague to another, completing the affiliation.
• Practitioners’ ability to shape the credentialing process through medical staff governance documents. "Physician leaders need to recognize that their bylaws, rules and regulations, credentialing manual, etc., are the foundation from which every process in the medical staff flows," says Mindy J. Hays, CPMSM, CPCS, manager of credentialing and medical staff services at West Chester (Ohio) Hospital. "Having strong governing documents makes day-to-day life in the [medical staff office] so much easier. When you have ambiguous or inconsistent information in these guiding documents, you open yourself up to potential risk."
• The fact that not every file can be expedited. Every time a file has to be expedited, another file that has been waiting gets pushed back, adding to the amount of days in the application process. "It takes extra staff time to take care of expedited files," says Ruppel.

Source: Medical Staff Briefing