Why do healthcare facilities and managed care organizations credential and privilege?

Although the credentialing and privileging processes may seem burdensome, applicants can take comfort in knowing that they will be working alongside other practitioners who have had to meet the same stringent requirements. There are a few important reasons why credentialing and privileging are conducted:

  • Patient protection. Keeping patients safe is the primary reason for credentialing and privileging. The organization must have appropriate processes so that only qualified and competent practitioners are providing patient care.
  • Federal and state regulations and accreditation standards: There are federal and state requirements for credentialing. The Centers for Medicare & Medicaid Services publishes requirements that must be met by every healthcare organization or managed care organization that wishes to provide services to Medicare and Medicaid patients. State regulations also set forth requirements. Accreditors, such as The Joint Commission and National Committee for Quality Assurance, set minimum standards that must be met in order to maintain accreditation. Failure to follow these requirements can result in the organization losing its ability to care for Medicare/Medicaid patients, losing its state licensure, and/or losing its accreditation.
  • Risk management concerns. If a patient suffers an adverse outcome as a result of negligence by a provider, the hospital where the care was provided can be held separately liable for negligent credentialing if it is found that the credentialing was not performed appropriately.

Source: The Clinician’s Quick Guide to Credentialing and Privileging