Medical Vendor Reviews

Structure of Credentialing

Structure of Credentialing

  • No healthcare worker should be permitted to work before completing the credentialing process. On the other hand, the healthcare institution should promptly perform the initial credentialing so that healthcare workers are not left in limbo for months. The governing board should do the final approval of credentialing.
  • External organization: Today, many agencies can verify credentials, and some healthcare institutions may work with these credential verification organizations to expedite the process, especially if the healthcare worker is from outside the United States or there is an immediate need for staff.
  • Healthcare institutions should regularly review the credentialing process so that any new state or federal recommendations are updated. Furthermore, each time changes are made in the credentialing process, legal counsel should first review them. The governing body usually does the final approval.
  • There must be administrative internal remedies for questionable candidates whose credentials are borderline.
  • Once a provider has been credentialed, the individual’s privileges should be reviewed every 2 years. This is very important because the provider may have learned new skills they may want to use. For example, a provider may have taken a course in bariatric surgery and may want to establish a program in the hospital. On the other hand, some providers may be getting old and prone to mistakes, and thus privileges for these surgeons should be limited to only certain procedures. Other providers may have developed an ailment like seizures or Parkinson’s disease, which may mean that they cannot work safely in the operating room, and thus privileges have to be curtailed.
  • The hospital should have bylaws that help establish a process for review and approval of applicants. The credentialing process and any decision should be documented and finally approved by the governing committee.
  • All employers have to comply with the Americans with Disabilities Act. The applicant cannot be discriminated against or denied credentialing just because of a disability.

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