Learning The “Secrets” of Physicians

How Important Physician Credentialing Is? Regardless if it is physician offices, managed care insurance companies, laboratories and hospitals, rest assure that all are credential physicians. Basically, credentialing is the act of obtaining information regarding a medical provider or doctor to assess their qualifications to practice their specialty profession. In reality, there are many different agencies today that oversee physician credentialing process. The URAC or Utilization Review Accreditation Commission is actually deemed to be the leading agency that is monitoring the qualifications standards and credentials in health care. Medical providers must be able to pass the process of credentialing before they could be hired by insurance companies and medical facilities. As a matter of fact, physician credentialing is sometimes called as medical credentialing and will verify licensure, training, education, quality as well as overall ethical standing of the healthcare provider in medical community. The credential process of doctors begin with medical provider submitting info to credentialing agency for review. A few of the areas of focus consist of board certification, to know specialty training and certification, education to verify the medical school as well as any post graduate training, licenses in which the doctor holds licenses, malpractice insurance, which ensures that there’s appropriate level of insurance, malpractice claims that is used to check for malpractice claims or awards, background check that is done to see if the person has any criminal history, resume detailing work history as well as personal references.
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The information is then gathered and reviewed via physician peer review committee. What this committee will do is make recommendations regarding the standing and professionalism of the provider in the medical community. The committees normally evaluate the medical provider’s ethical behavior.
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Basically, the insurance companies including government as well will research for the medical credentials of the physician before they decide to accept him or her into the group of participating providers. More often than not, they won’t be accepting any physicians who haven’t gone through physician credentialing to bill for services. A strict physician credentialing procedure is implemented by managed care organizations before a provider can be considered as part of the insurance company. The truth, there are lots of physicians who practice credentialing to ensure that their doctors are delivering quality health care to patients. Provider credentialing is so important because this assures patients that the medical providers have been assessed by their peers. This is providing high level of trust and set assurance that the provider is board certified and licensed and not had privileges revoked in other states. But this can’t be used in determining the quality of care provided but it is actually something that should not bother you as credential committees implement policies that mandate providers to partake periodic credential reviews and updates to keep their status active.

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