{"id":891,"date":"2017-04-26T10:56:26","date_gmt":"2017-04-26T10:56:26","guid":{"rendered":"http:\/\/www.ecareindia.com\/blog\/?p=891"},"modified":"2017-04-26T10:56:26","modified_gmt":"2017-04-26T10:56:26","slug":"everything-need-know-physician-credentialing","status":"publish","type":"post","link":"https:\/\/www.ecareindia.com\/blog\/everything-need-know-physician-credentialing\/","title":{"rendered":"Everything You Need to Know About Physician Credentialing"},"content":{"rendered":"
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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\u2019 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.<\/p>\n

Learn more about physician qualification and by extension, competency<\/strong><\/p>\n

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.<\/p>\n

Understanding the record of the physician<\/strong><\/p>\n

To prevent possible rejection of claims, despite the best of treatment it is safe to fulfill the process of Physician Credentialing<\/a>. 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.<\/p>\n

Giving the service payer a track record of the practitioner<\/strong><\/p>\n

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.<\/p>\n

Mitigates liability on the part of payer and hospitals<\/strong><\/p>\n

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.<\/p>\n

The process of credentialing<\/strong><\/p>\n

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.<\/p>\n

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.<\/p>\n

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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\u2019 bills alike through the review of various parameters of physician competency. This concept of … <\/p>\n

Continue reading “Everything You Need to Know About Physician Credentialing”<\/span><\/a><\/p>\n

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