Hospital Credentialing and Privileging
Hospital credentialing and privileging procedures are unfamiliar topics to most chiropractors. Unlike their medical counterparts most chiropractors are not trained in medical centers or hospitals so the topics of hospital credentialing, privileging, and competencies are not learned. Privileging is the process of obtaining the permission to practice in a hospital. Credentialing is the process of obtaining and verifying the documents that support the doctor’s qualifications to work at a hospital. You cannot become privileged at a hospital until you have been credentialed. You cannot become credentialed until you have been shown to be competent.
What are Privileges?
Privileges are the practice parameters that a hospital yields to a provider within their facility. If you practice in a hospital there will be a very specific list of privileges that you will be allowed to perform. A chiropractor would typically receive privileges that mirror the mainstream practice of chiropractic. Privileges will not exceed your licensed scope of practice and may be less than your licensed scope. For instance, you may be licensed to perform manipulation under anesthesia, but that does not mean that the hospital has an obligation to include MUA in your privileges. Chiropractors are rarely ceded hospital admission privileges.
What are credentials?
A credential package is a verified dossier of personal qualification, achievement, and trustworthiness that can be used to substantiate and verify competence and licensure. These documents represent evidence of training, licensure, expertise, and experience of a provider.
Why credential providers?
- To protect patients.
- To verify that doctors meet accreditation and state licensing standards.
- To verify that doctors are who they represent themselves to be.
- To confirm clinical competence.
What is needed for credentialing of chiropractors?
- Work history
- Certification of Education
o College
o Chiropractic College
o Internship
o Residency (if appropriate)
o Fellowships (if appropriate)
o Advanced Training or certifications
- Peer and professional references (usually within two years)
- Hospital Affiliations
- State licensures (all states or territories where you have been licensed)
- Claims History (include current and past insurance carriers)
The Sex Offender Registry, National Practitioner data bases, and Medicare Sanction data bases may also be used to ascertain appropriateness of candidates. Written, electronic, and personal confirmation methods will be used to verify education, risk history, and licensure.
Each individual facility will have its own requirements and forms for credentialing. This process may be time consuming and you should allow a month. During this process hospitals will meticulously confirm that your application is accurate. An honest application is expected. Withholding state licensures, locations of practice, work history, claims, or disciplinary actions are breaches of trust and will be grounds for dismissal and appropriate legal action.
Clinical Activity Files
Once a provider is credentialed, hospitals maintain a current Clinical Activities File (CAF) for that provider. The CAF is an ongoing element of the credentialing process.
Contents of a typical CAF:
- Approved staff appointments
- Delineated clinical privileges
- Department-specific criteria
- Copy of practitioner’s license
- Copy of BLS/ACLS
- Peer review data
- Letters from patients (the good and the bad)
- Documentation of any counseling
- Plans of supervision
- Productivity metrics
There is nothing mystical about the hospital credentialing process, but there is a sequence that needs to be followed. Knowing what to expect when you are seeking hospital privileges will help to expedite the process and will project confidence and competence to the facility.