EclipseHR Blog

Why Medical Staff Credentialing is Essential for Success

Posted on Mon, Jan 24, 2011

Incompetent or non-compliant medical providers expose a grave set of risks to patients, employees, hospitals and care facilities. When physicians, nurses, and other hands-on medical personnel are not exposed to a continuous credentialing and background screening system, or are not reported by their peers, they can pose a risk to patient safety and staff. It can also impact the medical facility and its ability to operate and serve the community in some of the following ways:

  • Negative impact to the medical provider's reputation
  • Outside vendors may not want to continue doing business with them
  • Hospitals can lose their accreditation or certification status
  • Loss of Medicare and Medicaid reimbursements for any case that the implicated physician was involved in
  • Potential fines imposed for each day the implicated physician retains privileges at the hospital
  • Sanctioning by the Office of Inspector General and imposition of a Corporate Integrity Agreement (CIA), which involves a stringent policy review and lengthy audit

The Benefits of Comprehensive Credentialing Programs
Hospitals can better protect themselves against incidents of incompetency by building a more comprehensive medical staff credentialing program. This will help the hospital to better mitigate financial, legal and brand risks that arise when bad physicians are caught, and help ensure only the best candidates are hired. Below are some of the main benefits of creating a more thorough medical credentialing process:

1. Mitigate legal risk
A thorough and ongoing credentialing procedure that meets all the requirements of The Joint Commission and the National Committee for Quality Assurance (NCQA), and includes an additional background check and criminal check, will help a hospital defend against liability in the event of malpractice lawsuits.

2. Reduce incidents of incompetence
Increasing the scope and depth of the credentialing process will help medical facilities reduce the number of poor physicians they hire and in turn reduce the rate of incompetent performance.

3. Maintain compliance and funding
Creating a consistent, proactive, and continuous credentialing policy combined with zero tolerance for non compliance with every medical practitioner can help medical facilities uphold their accreditations and certifications. It also helps maintain payments from insurance companies and allows for participation in federally funded programs.

4. Minimize financial risk
When hospitals are found culpable for inadequate credentialing, the ensuing audits may drain financial resources and personnel hours. Following best practices for credentialing can mitigate this financial risk.

5. Maintain an honorable reputation
Negative press can damage a hospital's reputation in the eyes of its employees, customers and in the case of private institutions, donors. Ensuring high credentialing standards will protect the hospital's integrity and ability to attract top-tier talent to work there.

Medical institutions rely on their reputation and quality of care to continue to serve their community. A credentialing program that is inadequate can put patients, staff and the institution at risk. By implementing a robust credentialing program, you will help ensure a safer work place, help mitigate risk and maintain a positive image.

Tags: medical staff credentialing, medical risk management, physician credentialing

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