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Medical Credentialing
Pre-Health Professional Development (HLTH 3300)
The University of Texas at Dallas
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Medical Credentialing ● Long process and application process (application is free). ● Speciality requires them to have access to a hospital (like anesthesiology or surgeons) → goes through medical credentialing. ● Any hospital has a medical credentialing department... depends on size of hospital = size of medical credentialing department. Beginning of Medical Credentialing ● Doctor goes to the office of medical credentialing in the hospital they want to “obtain privileges” (seeking to use suites to operate on patients). ○ Department called medical credentialing or medical staff services. ● They look at DAs and ask questions about training, residency, (what they do), references (peer ones) [5 from general surgeon if you are a surgeon], any current/pending lawsuits, have you had any privileges at other hospitals (what were they?). ● Separate field in healthcare. ● CPMSM→ Continuing Professional Medical Services Management ○ You have to work for 3 years and then take an exam. ○ If you want to move up (you have to work for longer??). ● Regular scheduled meetings of department (once every 2 weeks) → uring complete files on doctors and then 1 or 2 administrators and medical credentialing people draws applicants of all aspects. ○ If they choose to “grant privileges” to the applicant (person sends letter to doctor saying we grant you this → then they’ll have an internal process and training. ■ (this is how you refer patients, discharge, surgery, etc.). ● Granted privileges are one year at a time; don’t have to do the application again, but update with info (removal of license, etc.) ○ If there are DAs and substance abuse and abuse → hospital can just not give you privileges ● Surgeons and anesthes. = don’t have privileges everywhere ● Privileges may be revoked if professional is abusing patients and equipment, and hospital may fire them because $ ○ Removal of DEA license (??) ● If you get denied, you have to wait for another time. They also the places that you previously worked in/currently work in to see how you are doing ● Nurses and technicians have a similar process ● Association for this is NATIONAL ASSOCIATION FOR MEDICAL STAFF SERVICES (for those who want to work in medical credentialing) ● Some hospitals will ask a doc to purchase malpractice insurance ● Standards come from the NATIONAL COMMITTEE FOR QUALITY ASSURANCE ○ Non-biased, non-profit organization responsible for quality in healthcare
● JCAHO: Joint Commission on the Accreditation of Hospitals and Healthcare Organizations ○ Prevents bad doctors from working in the hospital ○ Thus a hospital doesn’t have its own standards, it follows the ones from JCAHO ● Bigger hospital = longer hospital (90 - 150 days) ○ You have to be licensed, pass all the board exams, have malpractice insurance in order to work ● If you have a problem with DEA license then it will be revoked. It can also be revoked if you don’t maintain malpractice insurance or the level of it ● Doctors aren’t employees per say; surgeons will have a separate office from where they operate ● Surgeons will bill for their procedures and hospital will bill for use of hospital ● DEAS = renew every two years, no CEUS needed ● Some hospitals require surgical nurses (part-time) to do medical credentialing
Medical Credentialing
Course: Pre-Health Professional Development (HLTH 3300)
University: The University of Texas at Dallas
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