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Earning Hospital Privileges: The First Step in Medical Credentialing

For a physician to practice at a hospital, he or she must be granted privileges. To receive these privileges, the physician’s credentials are reviewed and verified by the hospital. When this process completes successfully, the physician can treat admitted patients, perform medical procedures and use the facility for patient care. The physician then submits claims to the insurer for providing patient services in the hospital.

Hospital privileges are a prerequisite for health plan credentialing. So, securing these privileges should be the first step in credentialing. Health plans maintain networks of physicians, labs, radiology facilities and hospitals. If physicians do not have privileges at a participating hospital, they will not be allowed to join the health plan.

Prior to granting privileges, the hospital Credentials Committee reviews the physician’s background, including:

 
• Education
• Training
• License(s)
• DEA • CDS (if applicable)
• Board Certification
• Insurance Coverage
• Work History
• Medicare/ Medicaid Sanctions
• Malpractice Claims History
• TB Screening, Rubella Titers
• Criminal Background Check
• Reference Letters

In addition, applicants must submit proof of their experience in procedures, surgeries and other privileges for which they have applied. Once approved, the committee appoints the physician to the medical staff for one year on the initial appointment and every two years thereafter.

Hospital privileges are specific to the physician’s training, education and practice expertise. Before granting privileges, hospitals verify the primary sources for a physician’s credentials according to the Joint Commission on the Accreditation of Healthcare Organization. If the application passes the primary source verification process, it goes to the hospital’s medical executive committee, the credentials committee and then to the board of directors for final approvals.



Because the credentialing process for hospital privileges can take a very long time, and your health plan credentialing depends on your privileges, you must start the process early. Then, know what documents need to be provided to the hospital and make sure they’re accurate. Finally, understand the hospital’s approval process. If you learn as much as you can about hospital credentialing before you begin the process, you should sail through without a hitch.

ABOUT THE AUTHOR

 

Michelle McFarlane, R.N., M.S.N., M.B.A., is the founder and president of AddVal, Inc., Southampton, Penn. She founded the company in 1995, and it now represents more than 5,000 medical professionals. Her 25-year career also includes clinical care and graduate-level teaching. She holds master degrees in nursing and business administration/healthcare and finance. She can be contacted at 215-396-8972 and mmcfarla@addvalinc.com

CODAPEDIA LBCCC MGMA WHARTON HEALTH CARE

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