Utilizing the services of medical
professionals with the right credentials lends confidence to patients. Beset
with reports of poor medical intervention and rejected insurance claims, it is
important to choose the best physician. Physician credentialing helps patients
and payers of patients’ bills alike through the review of various parameters of
physician competency. This concept of enrolment is explained in brief below,
which will give a fair understanding of the process and its benefits.
Learn
more about physician qualification and by extension, competency
The qualification of a physician
can, to a certain extent is indicative of competency. Physician credentialing
involves the collation of information pertaining to completion of training by
the doctor and subsequent board certification. This is then followed up with
verification on the authorization granted to the physician to prescribe
medications.
Understanding
the record of the physician
To prevent possible rejection of
claims, despite the best of treatment it is safe to fulfill the process of Physician
Credentialing. The record of the physician in terms of
any reported or alleged malpractice in insurance claims etc., is maintained in
Physician Credentialing. This will prevent the raising of objections, if any,
taking into weightage, past history.
Giving
the service payer a track record of the practitioner
The track record of the physician is
vital information for the payer. Records such as personal history, work
history, employment background etc. help the payer during the vetting process.
It is an important factor that will help to keep out physicians with a record
that does not meet the requisite standards.
Mitigates
liability on the part of payer and hospitals
Physician credentialing helps
hospitals and payers to insulate themselves from greater risk, in the event of
liabilities. It is an acknowledged sign of due diligence exercised on the part
of the payer or hospital. This will safeguard them against possible liabilities
arising out of medical negligence.
The
process of credentialing
The process begins with the
submission of an application. This is followed up verification which will
factor all possible details of the physician such as location details, area of
specialization, focus on particular age group, proficiency in languages,
affiliation in terms of hospitals and medical groups, certifications by boards
and status of practice, etc. This information on verification, will generate a
lot of information towards the credentialing process. Similarly,
re-credentialing is a process that is mandatory after every three years. This
will list out any changes post-credentialing which will be of use to either the
hospitals or payers.
Physician credentialing smoothens
the process for payers during the raising of bills for insurance claims. It
also helps hospitals during the process of screening and employment of doctors
and specialists. Not only does it fulfill the criteria as laid down by the TJC
(The Joint Commission) and the NCQA (National Committee for Quality Assurance),
it also helps in grading the physicians. This can be achieved by benchmarked
weightage against each parameter that makes it all the more easy to make
decision.
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