Executive Summary: Credentialing Providers
Type of Provider being Credentialed
The provider being credentialed in the context is a physician, medical doctor in particular, for the verification of compliance or non-compliance with the laid-down procedures and practices.
Credentialing Process Steps
In this case, the credentialing procedure is to be carried out in a series of steps, the first of which is the listing of potential applicants. The second step is the collection of up-to-date contact information of potential providers for purposes of contacting them directly in case of need to do so. The information would be vital as it would be necessary to check in with the physician on a regular basis and send out multiple forms to his office. The third step of the process is the provision of specific instructions on the required information to ensure that the medical doctor is furnished with details on the information required for credentialing to enable their execution of the necessary preparations (Lee et al., 2011). The fourth phase is the performance of a thorough background check, whereby staff members go through all the information provided to verify its accuracy and truthfulness. Examples of information that is to be verified in the context include employment history, medical licensure in the state, time gaps in education or career and the like. The fifth episode is the requirement of peer references, the three who must be fellow physicians of the same specialty and should not be related to the provider in question. The next step in the case would involve weeding out poor applications in the interest of saving money to avoid a situation where the credentialing coordinator wastes time on an application that will not get to fruition. The next step is the investigation of malpractice claims and the credentialing should verify all the highlighted red flags by going through closed settlements and suits. The next phase is sending applications to the governing body for review, while the last one is using a checklist to track the nursing practitioners’ progress, and the checklist in the case would have to be checked on a weekly basis. The physician, on his part, should fill in the needed information on the provided form and submit it.
Educational Background Needed
The educational and professional requirement for the credentialing the medical doctor is graduation from a medical or professional school and verification of completion of at least one-year postgraduate training.
Whether the Provider has an NPI Number
The provider in the context has a type I National Provider Identifier (NPI) number.
The State that the provider will work in
The provider will practice physician and specialist services in Texas.
Whether there is a Standard Application
In this case, a standard application is in place and assumes both verbal and written forms. The application evaluates, among other factors, the applicants’ readiness to provide continuous patient care, applicant’s knowledge of hospital bylaws and the code of conduct, readiness to allow credentialed workers to access patient medical records, worker’s readiness to submit to a mental or physical exam, and the need for additional requirements (McFarland et al., 2018).
The Need for an Onsite Visit
In the context, an onsite visit would be necessary for the verification of the information provided and would help in the uncovering of possible red flags. Some red flags would be evidence of poor program evaluations more than once, sudden relinquishment of medical staff membership, and an unusually high number of professional liability actions (Faulx et al., 2017). Moreover, the visitors would study practice patterns such as attendance patients, personnel population, and hours of operation to ascertain compliance or lack of it thereof.
Specialists that may be Credentialed
Various medical specialists may be credentialed and examples would be Advanced Practice Registered Nurses, audiologists, chiropractors, clinical psychologists, licensed behavior analysts, licensed dieticians, and midwives. Others may include occupational therapists, optometrists, physical therapists, speech therapists, and marriage and family therapists.
The Facilities that are Credentialed
It is a requirement that all healthcare organizations be credentialed prior to commencement of operations. Furthermore, healthcare institutions should regularly review the credentialing process for purposes of updating recommendations.
References
Faulx, A. L., Lightdale, J. R., Acosta, R. D., Agrawal, D., Bruining, D. H., Chandrasekhara, V., ... & Kothari, S. (2017). Guidelines for privileging, credentialing, and proctoring to perform GI endoscopy. Gastrointestinal endoscopy, 85(2), 273-281.
Lee, J. Y., Mucksavage, P., Sundaram, C. P., & McDougall, E. M. (2011). Best practices for robotic surgery training and credentialing. The Journal of Urology, 185(4), 1191-1197.
McFarland, M. S., Groppi, J., Ourth, H., Moore, T., Jorgenson, T., Torrise, V., & Morreale, A. (2018). Establishing a standardized clinical pharmacy practice model within the Veterans Health Administration: Evolution of the credentialing and professional practice evaluation process. Journal of the American College of Clinical Pharmacy, 1(2), 113-118.
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