Employed physicians and credentials verification
The Medicare provider database reportedly lists thousands of doctors and other providers as graduates from medical schools that have been defunct for a century, according to a MedPage Today story posted last week. Many of these errors were apparently caused by the practitioner inadvertantly hitting the wrong school on a drop-down listing as he or she entered information on a Medicare website.
The practitioners are probably not making the same error during the credentialing process, but the MedPage article shows the importance of vigilance when it comes to credentials verification—this week's CRC Daily topic. The week kicks off with a look at credentials verification for employed physicians.
Q: Must employed physicians be credentialed and privileged?
A: Yes, they must, if their employment requires them to either hold membership on a hospital medical staff and/or to be granted privileges by the hospital.
One possible exception is this three-part consideration:
- The physician is 100% in an ambulatory setting;
- The practice site is a hospital/health system corporation with its own unique (non-hospital) CMS billing number;
- The physician does not require any hospital-based privileges.
That said, it is still best practice and the most efficient use of hospital resources to have one single process to handle all employed physicians. Your organization can be assured that every candidate has been fully vetted at least once through the same prescribed process.
Q: Who does the credentialing and privileging?
A: It depends, but regardless of who does it, the process must be the exact equivalent of what is done for non-employed physicians to meet all accreditation and regulatory standards of the CMS Conditions of Participation. The reality is that in most hospitals, this function will be carried out by a medical staff services department (MSSD) either working internally or externally with a credentialing verification organization (CVO). A rare hospital might not have a MSSD and delegate this to human resources.
From “Employed Physicians as Medical Staff Members Part 3: Credentialing/privileging—a policy approach,” by William K. Cors, MD, MMM, FACPE, Chief Medical Officer, Pocono Health System; East Stroudsburg, Pennsylvania. This column appears in the August 2015 edition of HCPro’s Medical Staff Briefing newsletter.