The Credentialing and Privileging Process
Healthcare organizations are legally responsible for assuring that individuals providing patient care are credentialed, verified, and competent to do so. In order to guarantee compliance and quality patient care, the Centers for Medicare and Medicaid Services (CMS), National Committee for Quality Assurance (NCQA), and Health and Human Services (HHS) require that members of the medical and allied health staff are properly credentialed and privileged.How does a physician become credentialed? Credentialing and privileging are both necessary before a physician is permitted to practice. The credentialing process verifies and assesses that a practitioner’s qualifications and license status are in good standing to provide healthcare services.Alongside credentialing, privileging authorizes a licensed or certified healthcare practitioner’s specific scope of patient care services and evaluates an individual’s clinical qualifications and/or performance. Privileging ensures that medical staff are...