Usually in people’s minds, the idea of a physician’s credentials connotes education, licenses, and certificates. But that is only a small part of physician credentialing. It also has to do with the performance level of a doctor and how his patients rate him.

Improper credentialing can cause patient injury, as well as making it difficult to keep a good, qualified medical staff. And, if an unqualified physician is allowed to be hired, hospital personnel may be required to address any problems that may arise with him. This can be so difficult that it is sometimes not done until it is too late. This can cost the hospital business or result in expensive law suits.

To avoid these problems, it is imperative that a hospital track a physician’s credentials. They do it using an impartial Physician Credentialing Committee controlled by other 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.

Not only does Physician Credentialing increase quality of care to patients, it also enables doctors to maintain membership in insurance networks. Among these would be government organizations like Medicaid. A number of companies have implemented custom credentialing requirements that must be followed in order to be a part of them.

If a hospital does not keep track of which of these programs a doctor has completed, and they unwittingly pair a Medicaid patient with a doctor who is not qualified to accept it, they will not be reimbursed. This can cause problems for both the patient and the doctor. On the flip side, if they turn away patients from a doctor who is qualified, they can lose a lot of money.

In conclusion, it is important for a hospital to keep track of a physician’s credentials for the sake of the doctor, his patients, his colleagues, and the hospital he works for.

This helps avoid costly and dangerous mistakes, increases hospital morale, and enhances patient satisfaction. More importantly, it has the potential of protecting a patient’s life from an incompetent or unqualified physician.

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