Credentialing & Privileging

Determining who must be credentialed

Credentialing Resource Center Connection, September 28, 2006

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It was "super-fantastic" to see so many of you at the National Association Medical Staff Service (NAMSS) event in Atlanta last week! I know that many of us renew our energy every year at the annual NAMSS conference by networking with our peers, sharing ideas and best practices, and just getting out of our day-to-day routines. 

 

Last week, I responded to the frequently asked question of whether healthcare industry representatives (HCIRs, e.g., medical device manufacturer representatives) must be "credentialed." This inquiry stems from the much broader question: "Who must be credentialed?" Ambiguity on the part of medical staff professionals (MSPs) about the answer often leads to added work and responsibilities for the medical staff office.

 

Let's begin to clarify which individuals must be credentialed by looking at the definition of the term credential as a noun from the Encarta Dictionary:

 

1) Proof of ability or trustworthiness; a certificate, letter, or experience that qualifies somebody to do something

2) Authentication; anything that provides authentication for a claim

 

By these definitions, it seems logical to require proof or verification of ability and qualifications from anyone who provides services or performs a specified task or job responsibility in a hospital setting.

 

You can group the types of employees and staff into the following buckets when answering the question, "Who must be credentialed":

 

§         Hospital employees

§         Licensed independent practitioners (LIP)

§         Contracted individuals providing care, services, or treatment

§         Healthcare industry representatives

§         Dependent practitioners

 

Credential is also a transitive verb, requiring both a verb and one or more objects.  For example, "The MSP needs to credential all practitioners."

 

But wait a minute. I'm sure you have just recognized that this is a misstatement-the MSP does not need to credential all practitioners, even though all practitioners need to be credentialed. Good catch.

 

All too often, when the term "credential" is involved, the task is mistakenly assigned to the medical staff office, resulting in practitioners being processed through the medical staff standards who do not have to be. Remember to always analyze current processes to avoid duplication of work and to develop policies and procedures that allow for the simplest route for credentialing all types of practitioners. Medical staff offices working



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