| Summary: |
Annotation This handbook enables your organization to systemize the tedious, ongoing, and mandatory process of credentialing your medical staff - and to understand why you must! Healthcare organizations lose substantial revenue when providers on their medical staff are not properly credentialed. Payers have unique requirements for providers to satisfy before they will pay for services. Hospitals often face difficulty in getting the information from the provider and are challenged by a lack of systems for initial and ongoing verification and documentation. Administrators must weigh the cost benefits of in-house or outsourced credentialing and evaluate the options for software and other tools. Readers who use this handbook will feel confident and secure in their knowledge. Healthcare organizations must have credentialed medical staffs to deliver their services. The reasons are two-fold: First, educated, licensed, experienced, and proven caregivers ensure that a hospital or medical practice is capable of delivering quality care. Secondly, payers require that the physicians and other licensed healthcare professionals are qualified and licensed to work with their patients. Before receiving payment for services, the provider must have specific credentials for providing that service. Verifying and documenting the credentials of a healthcare provider is tedious, ongoing, and mandatory. An organization with a large medical staff may struggle with keeping the credentialing function current, as many licenses have rolling expirations. Credentialing ensures that clinical practitioners are duly qualified, licensed, and board certified. It reports the history of malpractice claims, state-instituted sanctions, or other undesirable professional circumstances of providers. Credentialing and privileging of healthcare professionals protects patients and hospitals by minimizing the risk of medical errors that may result from the work of incompetent providers. It also. |
E-book
