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Doctor Credentialing - The Process That Ensures Your Doctor Is Up To Scratch

Jul 15, 2008
Most doctors tend to place their residency and medical school diplomas on their office walls for all to see because it necessary that their patients feel that they have come to a reliable doctor and are in the safe hands of an experienced health professional. Though these diplomas are definite signs of accomplishment for physicians and health practitioners, they don't necessarily guarantee quality. In order to provide this guarantee, a stringent, although not federally required, legal process has been created wherein health organizations and physicians can become accredited in order to provide doctor credentialing.

Credentialing physicians is the formal process of attestation and recognition of the current medical and technical competence as well as performance of a doctor by monitoring and evaluating his or her medical or clinical decision-making abilities. Furthermore, physician credentialing verifies medical education, certification, training, license, experience, malpractice, technical abilities, clinical judgment, and if any, adverse clinical occurrences through observation and investigation.

A doctor's credentials describe the scope of medical practice and the clinical services that he or she provides. It also ensures that the doctor is provides services that are of a desirable standard. Doctor credentialing is the product of certain objective peer reviews that utilize criteria established through common professional, administrative and legal practices. The criteria are usually directly related to quality of health care and the performance of the concerned physician.

The reviews are expected to be fair, reasonable, arbitrary, performed in good faith, justifiable, have extensive documentation, and equally applicable to all. The decisions made regarding doctor credentialing should be protected and confidential. In cases where there are adverse decisions being made, certain avenues of appeal and the inclusion of legal hearings are expected to be made available to the doctor who is being assessed. There are certain professional standards when credentialing a doctor and these include whether or not he or she provides quality and timely medical care, whether there over or under utilization of medical resources, and so on.

Patient referrals to physician specialists or outpatient clinics are generally not considered as important factors in the physician credentialing process. During the process of physician credentialing in the United States, everything from hospitals, HMO and the state boards of licensure, to the managed care entities and different organizations have to address two main issues. One issue deals with factors that confirm the physician's background information, like graduation, residency, and whether or not the certification is valid. The second issue deals with the physician's special request for the rights to provide care for a select spectrum of patients. A lot of healthcare facilities and even doctors today are finding themselves entangled in malpractice suits for incompetence or for hiring incompetent physicians. Thus certain legal processes have been designed for effective doctor credentialing.
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For more information on the
doctor credentialing process go to
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