Why Does Physician Credentialing Matter?

Posted on July 17, 2009
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by Francis Singletary

Most people, when they think of a physician’s credentials, think of licenses, certificates, and education. However, physician credentialing is much more than that. It involves the duties a doctor performs and how well he performs them, as well as levels of patient satisfaction.

When a hospital does not ensure the credentialing of its physicians, patient injury may result, as well as difficulty in retaining a qualified staff. Personnel of the hospital may be the ones who have to deal with his problems if an unqualified doctor is somehow hired. This issue is difficult to deal with and may not be addressed before it is too late. It could also be very costly to the hospital, or result in law suits.

In order to conquer these problems, it is necessary that a hospital maintain record of a physician’s credentials. This is possible through an impartial Physician Credentialing Committee consisting of fellow doctors.

The committee comes up with decisions according to the accepted laws and standards which also have to be accessible by the community at large. Included here are not just a physician’s general practices but the quality of patient care. The measurement criteria may vary from one specialty to another.

Besides increasing the quality of patient care, Physician Credentialing has other benefits as well. For example, it allows the doctor to be a member of insurance networks, including government entities such as Medicaid. Many companies have their own credentialing requirements that doctors must follow to be a part of them.

When the hospital fails to keep track of a doctor’s completion of these programs, and they unknowingly put a patient of Medicaid with a physician who cannot accept them because of qualifications, there will be no reimbursement. Contrarily, if patients are not seen by doctors who do have the qualifications, there is the potential to lose large amounts of money.

To sum up, when a physician’s credentials are not kept track of in the proper way, the doctor himself, the patients, employees, and the hospital all suffer the effects.

Not only will this aid in preventing dangerous and costly mistakes, increasing employee satisfaction, and raising patient satisfaction, but it could possible save some lives from incompetent or unqualified physicians.

About the Author:
It is important that we as healthcare patients can feel sure that our physicians are credentialed and qualified. The certificates and licenses make us feel good about the doctor’s abilities. On the physician’s side, physician credentialing is important for employment and job stability. It is important that hospitals keep good track of it with good credentialing software.

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