Credentialing is an important aspect of the health care system by which health care facilities and insurance companies provide patients and policyholders assurance of the qualifications of the physicians and other licensed staff with whom they are affiliated. The credentialing process involves not only evaluating the qualifications of a licensed health care provider, but also his or her practice history.
In the credentialing process, a licensed health care provider’s history will be examined, including his or her training and education, licenses and any certifications. A provider’s practice history, including any malpractice claims and licensure-related discipline, will also be examined in the credentialing process. In addition, credentialing also requires physicians to prove that they are capable of providing up-to-date care. An important point to make, however, is that credentialing doesn’t guarantee that a licensed health care provider will provide a certain level of care to patients, but is supposed to evaluate a provider’s qualifications, which is certainly important.
Earlier this month, a Twin Cities news station reported that records show that Veterans Administration hospitals in both Minnesota and Wisconsin have been providing misleading information regarding the credentials of some VA physicians. The VA, in response to the report, said that it is looking into what caused the errors. The kind of failures cited in connection with VA physicians could potentially result in negligent credentialing litigation, at least for non-VA hospitals and medical facilities.
Credentialing is certainly an important process licensed health care professionals must submit to in order to participate in the profession. Navigating the issues that can arise in the credentialing process is not always easy, particularly when a provider doesn’t have a perfect practice history. When questions arise in the process, whether related to the law of credentialing or other technical matters, it can be helpful to consult a legal advocate with experience in this area.