Residency

Resident credentialing basics

Residency Program Insider, August 14, 2007

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Credentialing is the process by which a hospital obtains and validates evidence of an applicant's medical education, training, and history in order to review and assess his or her professional qualifications for medical staff appointment.

 

Healthcare purchasers, legislative leaders, and consumers all exert various pressures on hospitals to thoroughly evaluate the qualifications of potential medical staff members, and virtually all major accreditors now require hospitals to have an active, documented credentialing processes.

 

One part of the process that may be confusing to those outside a medical staff office (MSO) is the difference between credentials verification and credentialing. Credentials verification-determining whether a practitioner's credentials are authentic and valid-is only one aspect of the overall credentialing process.

 

For example, credentials verification consists of determining whether a physician completed his or her residency and authenticating the dates of that residency. When an MSO requests this information from a residency program, this can also be called primary source verification.

 

The term credentialing, however, refers to the overall process of gathering and verifying credentials information, reviewing that information, and making a decision to grant or deny medical staff membership. For example, medical staff offices are charged with verifying physician competency, which may include asking that physician's residency program for verification of competency, case logs, and procedures completed.

 

Because hospitals usually want the program director to provide this information, but the task of gathering the requested information may fall to the residency coordinator.

 

The following outlines the credentialing process that will ensue once a graduated resident applies for a medical staff position/privileges at a hospital or other organization.

 

  1. The resident graduates from his or her program.
  2. The resident seeks medical staff membership/clinical privileges in a hospital, surgery center, or clinic, OR a position with an organization that employs their practitioners.
  3. The resident will need to obtain an application from human resources and/or the medical staff office (MSO) of the organization
  4. The application will ask for education/training dates, which will need to be verified by a primary source (i.e. from the school/program)
  5. The medical staff professional and/or human resources personnel will contact the school/medical center where the resident received their training via letter, e-mail, or fax to verify that the information on the application is accurate.
  6. The residency coordinator may or may not receive this request, as it would go to either the MSO or human resources department of the training organization. The MSO or coordinator would respond with a letter, e-mail, or fax citing dates of attendance and program completion. In many cases, the credentialing organization will request the program director to complete an evaluation form. The form will attest to the competency, knowledge, citizenship, and well-being of the resident while they were in the program.
  7. The hiring organization uses this information to ensure that the provider under consideration is qualified for the position/privileges that the provider is requesting.

 

 

All the best,

 

 

Sheri Patterson, CPCS

Medical Staff Professional

The Greeley Company



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