Comparing Credentialing to Privileging: Why Hospitals Need and Use Both

Hospitals Need

By now, it should be time that you had a more modern way to handle your physician credentialing requirements. Gathering information and paperwork should be a thing of the past, as there are much easier means to keep the right files on physicians in this day and age.

But for those that are curious about whether or not credentialing and privileging are the same, they are actually two different things in the medical and hospitality industries. Here are details about both credentialing and privileging and what sets them both apart.

Credentialing

To sum up credentialing, it is the process and verification of a physician’s records. These records would include college degrees, certifications, licenses, references, and more. Credentialing essentially confirms information that a physician provides you in his or her documents.

Credentialing is used by insurance companies to ensure that physicians that you hire are legitimate and reputable. A medical facility such as yours needs to work with a number of different insurance companies. This is so that when a patient is insured with one of the companies you work with, you can get paid as soon as possible.

Privileging

While not the same as credentialing, it is considered a practice that is complementary to it. With privileging, a physician is granted permission to give the care that they have been trained to give at a hospital, clinic or facility.

To gain privileging, the physician first must apply for privileges. Hospitals and medical facilities commonly create brochures for how to apply and what the physician needs in order to obtain privileges.

People might also mistake privileging for membership, as membership is often described as the physician becoming a member of a medical team. Privileging grants the physician to perform tasks and procedures they are trained to do, whereas membership gives the physician exclusive benefits for begin a staff member.

What Do Hospitals Do with Credentialing and Privileging?

Seldomly, medical facilities will grant a temporary approval for privileges, while credentials are waiting to be reviewed for verification. It is a good idea for physicians to obtain what is called primary source verification (PSV) to avoid long delays or potential roadblocks along the way. PSV is verification from a school, licensure, professional, or any other body with authority to determine a physician’s qualifications.

A committee is often the group of people who are in charge of conducting the credentialing process. This committee consists of other physicians who are granted privileges in the medical practice. Medical facilities can have more than one committee, and the applicant physician can be referred to one of these committees based on his or her expertise. For medical facilities that perform credentialing in-house, staff undertakes the administrative process of both privileging and credentialing and then relays their information to the administrative figure for a final decision on whether or not to hire the physician.

In summary, credentialing is the verification of a physician’s past history, whereas privileging is the ability to give that physician the right to give care to patients in a certain medical facility. Both processes often go hand in hand with one another, as qualified physicians need to also apply for privileges to let insurance companies know who is giving care to patients.

The best way to handle your physician credentialing today is simply to hire a physician credentialing service to do it for you. For any candidates that are looking to get a job in your facility, a credentialing service can do the heavy lifting for you so that all you have to do is choose the most qualified physician based on easy-to-read reports created by credentialing representatives.

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