Credentialing best practices

Credentialing will never be easy, but it can and must be done effectively. Understanding and following credentialing best practices will provide a solid foundation for achieving consistent, excellent performance. Marna Sorensen, CMPSM, who has more than 20 years of experience in the medical staff services field, shares the following best practices for credentialing:

• Practitioner credentialing exists to protect the patient, not to “pass” accreditation surveys (refer to The Ultimate Question). When done effectively and consistently, credentialing also protects the organization and its credentialed providers.
• The medical staff office does not make medical staff membership decisions—this is solely the responsibility of medical staff leadership. However, the medical staff office does provide as much information as possible for those who will make the final decisions regarding medical staff membership.
• Excellent credentialing processes require clear, consistently applied criteria, and if your processes are functioning properly, not all applicants will meet those criteria.
• An application that is stopped during the verification process due to missing or conflicting information is not a denial.
• Medical staff membership is not automatic, and the burden is on the applicant throughout the credentialing process. Therefore, it is up to the applicant alone to answer all questions to the satisfaction of those involved in the credentials process.

Source: The Medical Staff Office Manual: Tools and Techniques for Success