The issue of provider credentialing poses some challenges to offering a simple explanation. Since this is more a "process" than a condition, explaining credentialing does not lend itself to a short, all-encompassing definition. Yet, provider credentialing is vital to ensuring quality care, which has become a critical measurement rule for healthcare providers.
The Department of Health and Human Services (HHS) definition of "credentialing" reinforces the process-focus of this requirement. According to HHS, credentialing is "the process of assessing and confirming the qualifications of a licensed or certified healthcare practitioner."
This official definition area of PIN 2001-16 also offers primary and secondary sources of information to properly vetting healthcare providers' credentials. HHS suggests the following sources to verify physician credentials.
Primary Verification Sources
* Electronic or mail correspondence,
* Telephone live-person verification,
* Internet investigation that offers verification, and
* Published reports offered by credential verification organizations (CVOs) and entities.
Secondary Sources of Verification
Should primary source verification be unnecessary, HHS recommends using these secondary sources to credentialing healthcare providers.
* Get evidence of the original credential,
* Secure a notarized copy of the credential, and
* Make a copy of the credential from the original document (must be approved by appropriate Health Center staff).
How to Accomplish Physician Credentialing
To accomplish sufficient credentialing, the following are acceptable evidence of primary and secondary verification of credentials. (P = primary source; S = secondary source)
* Current, in-force license for a licensed independent practitioner [LIP], (P)
* Evidence of appropriate education, training and experience, (P)
* A statement of satisfactory health fitness from the health care provider and confirmed by the chief of staff, training program director or another licensed physician appointed by the health care facility. (P)
* Government-issued picture ID, (S)
* Drug Enforcement Administration (DEA) registration confirmation, (S)
* Hospital privileges verification, (S)
* Immunization and PPD (purified protein derivative) skin test status, (S) and
* Current life support training evidence. (S)
Please note: These requirements are somewhat different than health center accreditation standards. When a health care facility seeks accreditation, management should consult the HHS standards for accrediting a health center.
Outsourcing Medical Billing, Coding and Meaningful Use 2
These requirements also generate challenges in medical billing and coding. While the Centers for Medicare and Medicaid Services (CMS) initiated the Meaningful Use regulations, other payers are adopting some provisions, particularly the use of electronic health records (EHRs).
Physicians who began complying with Meaningful Use Stage 1 in 2011, are ready to advance to Stage 2, satisfying the required two years of Stage 1 compliance. After releasing a final rule in August 2014, CMS permits physician flexibility in using Certified Electronic Health Record Technology (CEHRT) due to the delays in CEHRT certification implementation.
In many cases, physicians involved in becoming credentialed, have little time to install CEHRT. Providers and facilities involved in credentialing should consider outsourcing their medical billing, coding and documentation tasks.
By outsourcing these duties to a top firm, such as M-Scribe Technologies, physicians, hospitals and health centers reap multiple benefits. Two primary benefits alone are worth evaluating this option.
First, physicians can control their practice costs. With cost certain accuracy, third party billing and coding organizations afford physicians with impressive budget control.
Second, since the best firms offer compliant billing and coding efforts by well-trained staff, physicians have the comfort of knowing their critical billing/coding functions are being properly managed.
Follow the HHS roadmap to properly credential physicians. The way you implement the process is your call, but the HHS is specific on the best primary and secondary evidence needed to fulfill this necessity.