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Credentialing 101: Becoming Credentialed for the First Time

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Credentialing 101: Becoming Credentialed for the First Time

A physician is required to go through the credentialing process each time they switch employers or ask for new privileges. 

Credentialing is one of the first stages of working as a practicing physician for residents and fellows who are nearing the end of their training. A physician's education, training, and experience are verified and evaluated during the procedure. Patients can feel confident that they are in capable hands, and doctors can trust one another.

Enrollment in a physician health plan requires credentialing as well, so that services can be paid for. Having a solid understanding of the procedure and how to use it will help residents as they start their fledgling careers as a physician.

From a resident's perspective, the most important thing is to know that this process exists—that you need to be prepared for it; there is a lot of information and paperwork to gather and complete, and it's the physician's responsibility to be on top it.

Here's how final-year residents might assess their readiness for the labor market.

Have your data ready

Physicians must complete rigorous credentialing applications when taking a new post. It's a good idea for folks who plan to accept a position soon, in order to have that information and any necessary supporting documentation on hand.

These particulars are:

Ensuring your AMA Physician Profile is complete and accurate is also advantageous. The organization you are applying to for a job may request a copy to confirm the information you supplied on your application is accurate.

The profile contains information that credentialing specialists are looking to obtain from authoritative (primary) sources such as state license boards, medical schools, training programs, and others,

Physicians are also encouraged to download their personal free self-inquiry profile on AMA Profiles Hub. This is the information that a hospital or a payer is going to see when they are seeking to verify your data.

When should you start compiling your information? 

Residents should be exposed to the process while still in training. Keeping track of credentials isn't a single task. It should be approached as an ongoing process that physicians benefit from, being able to quickly access their most up-to-date information and documentation.

Credentialing is a Three-part process

Credentialing traditionally sets off a three-phase process. The first is credentialing, during which qualifications are verified and assessed. The second is privileging, which gives you permission to perform specific services at the institution based on your credentials. The third is enrollment, which allows you to bill and be paid for those specific services.

Takeaways

As residents move into the next stage of their career and become certified physicians, the provider, insurer, and health facility have legal obligations to verify credentials before they issue privileges. 

Subsequently, it's the responsibility of the new physician to ensure they have up-to-date and accessible credentials to share with their new employer and insurer to make this process as efficient as possible. 

The key takeaway for fledgling physicians is that it's not a one-time deal. They should maintain their documentation so the re-credentialing runs smoothly, instead of having to run around updating documentation at the last minute.

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3 Reasons Providers Fail CQC Inspections

1
“No system to ensure all staff have full pre-employment checks completed”
2
“Failure to deploy adequate numbers of suitably qualified staff”
3
“No system in place to review and communicate role-specific training or policies to staff”

Are you CQC ready?

Yes
No
1. Do you think there is there a link between staffing and the ability to deliver safe, effective services?
2. Do you have any digital tools, such as online staff management, that can help get the right people on duty at the right time?
3. Can you automate key aspects of employee onboarding to ensure the right mix of skills is available within your teams?
4. Can you evidence documents, DBS checks, right to work checks, certifications, training records, policies and reporting for CQC inspectors?
5. Is all your documentation regularly kept up to date?
6. Do your staff understand their responsibilities and how well can they link their work back to current guidelines and best practices?
7. Can you evidence that policies are communicated to staff and they are read and understood?
8. Do you have a digital document management system in place to ‘send and sign’ new or amended policies or documents to staff?
9. Do you record staff training and development that you can show CQC inspectors?
10. Can you provide clear evidence of how you are developing and improving your services?

Take Action

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