Question

In this submission, reflect on what aspects need to be considered when credentialing a physician for a medical facility. Credentialing is more than the education and background check. HInt: Many times payment is made by insurance! Discuss all the credentials that must be maintained for the physician and why. Reflect on the challenges that could be faced for the facility, the employees, and the clients if this process is not completed in a timely fashion.

Answer 1

Credentialing is a critical procedure for all health care facilities that must be carried out to ensure that they are eligible to do so with all health care professionals who will be delivering the clinical services. One of the main certification features is to search for any certificate , diploma, or degree with the primary source. For qualifications, merely requiring the healthcare provider to request an original certificate or degree is no longer enough. In addition, as regards education and training, the health care agency or licensing board must also consult with the primary source. Furthermore, information should be gathered on any allegations of malpractice and many other factors which could influence clinical practice.

For privileges and credentialing, the bylaws should address the following:
1.   The pre-application process to test whether a health care professional meets the basic requirements for hospital work
2.   Set reasons for rejecting applications after pre-application
3.   Establish a process in which the rejected health worker can reapply after initial refusal
4.   Have a rapid certification process for locums, emergency services and short-term jobs
5.   Have laws in place to restrict medical practice for those healthcare staff who do not meet guidelines or the quality of treatment is not adequate
6.   How to grant temporary privileges: Often an approved medical or surgical specialist might be asked to give advice or conduct a life-saving operation, and the bylaws should be able to accommodate them in those cases.
7.   Giving emergency privileges to healthcare workers in times of crises (for example, in flooding or earthquake, there might be an immediate need for the personnel to care for the patients.
8.   Create a code of behavior for a credential health worker and the consequences for disregard
9.   Giving shadowing privileges: Often, doctors and surgeons from outside the United States may have different experience, and these healthcare professionals may require shadowing for a few weeks or months before granting full privileges.
10.   Providers of Telemedicine
As healthcare delivery progresses, some doctors are now authorized to practice telemedicine but within reason. Radiologists also assist emergency departments by examining CT scans or dubious midnight X-rays. In fact, the Medicare and Medicaid Services Centers now allow healthcare institutions into which patients are admitted Telemedicine systems to offer rights and qualifications to certain doctors who perform outpatient surgery and teleradiology. It should be noted that most licensing boards do not provide for the prescribing of controlled drugs or the telemedicine review of patients. The hospitals must have a strict policy for telemedicine practice because it has the potential for violence. Many insurers and state licensing boards are still committing to telemedicine practice with supervision to ensure patients receive sufficient treatment.
11.   The applicant should consent to give patients continuous treatment at an appropriate level of care
12.   The applicant may accept receipt of the bylaws, legislation, guidelines and Code of Conduct of hospital. A copy of the bylaws is to be signed, dated and returned to the certification committee.
13.   Still have in writing that all accredited healthcare staff have access to medical records for patients, but medical records are audited at random to determine accuracy and competence
14.   The health-care worker should provide health status and vaccination records. Most hospitals also have a provision to vaccinate doctors against hepatitis B. Some hospitals need even require an annual influenza vaccine.
15.   If a need exists, the health care worker must agree to a mental and or physical test, as prescribed by the agency. Failure to agree can result in privileges being revoked or suspended without the right to a hearing.
16.   If the health care system requires extra rights, it can request the application in writing
17.   The applicant must sign and agree to the validity and completeness of all proof, facts, and diploms. Any errors or omissions may be grounds for the automatic revocation of rights or the request being revoked.
18.   Potential cases may be given to the health care provider and they may recommend treatment options. This can be done orally or by email.
19.   In certain cases, it might only be possible to study a historical chart of the patient records. This should be performed uniformly on all healthcare professionals who care for patients to ensure that they comply with the standard for writing medical notes, dating each entry, testing the criteria of the test, and tracking any suspicious results.