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Physician Credentialing Checklist

Posted on Mon, Jan 24, 2011

Physician credentialing is the process of verifying and recognizing that a physician is qualified to practice medicine. Credentialing is usually done by a medical staff credentialing service for healthcare providers as well as insurance companies, and should occur many times over a physician's career. Continuous credentialing protects the organization by ensuring the physician working for them is qualified for the position at all times.

Physician Credentialing ChecklistStep 1: Education and training

Credentialing includes verifying medical school education and any residency work that the physician did after medical school. Grades are examined as well as references from instructors and colleagues.

Step 2: License and Certification

Examining the physician's state board license and certification is another aspect of credentialing. All paperwork must be in order for the physician to receive privileges at their organization. Becoming licensed requires credentialing by the state medical board, which will ultimately award the physician licensure.

Step 3: Experience

The experience the physician has had with patients is also evaluated during the credentialing process. This includes the following areas: bedside manner, scope of practice, patient care and experience with various clinical practices. this determines the areas of clinical work the physician will be privileged to work in at a particular organization.

Step 4: Medical Malpractice and Negative Clinical Occurrences

The credentialing process includes reviews of any past events in the physician's practice that led to negative clinical occurrences or malpractice lawsuits. This may include harm to patients, harm to colleagues or legal issues during practice. It is a judgement of the credentialing body to determine whether the physician had had too many incidents of this type to justify providing him with privileges.

Step 5: Character

The physician's character is evaluated through observation in addition to recommendations from past employers and colleagues. Physicians are expected to work under the American Medical Association's code of ethics, which specifies behavior and practice that leads to good character. Protecting patients from harm is very important in physician character, as well as honesty, collaboration and confidentiality.

Resources:

American Medical Association

Tags: medical staff credentialing, physician credentialing

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