Credentialing is NOT Privileging
In healthcare vernacular, ‘Cred/Priv’ is often a phrase employed to cover both the processes of Credentialing and Privileging. Though this interchangeability suggests a kindred link between the two, it’s essential to understand that Credentialing and Privileging are distinct yet interrelated stages in a practitioner’s medical career, each possessing significant implications for patient safety and healthcare quality.
While Credentialing is about verifying a healthcare professional’s qualifications and competency, Privileging refers to the authority granted to practitioners to undertake specific clinical activities or procedures within their field. It’s crucial to identify and appreciate this differentiation, not least because it bears heavily on reimbursement in 2025 and beyond.
Scrutinizing the Current Status of Credentialing and Privileging
Many institutions grapple with several challenges connected to Credentialing and Privileging. They range from a lack of regular review and standardization of privileges to the complexity of the process, lack of ongoing evaluation, and inconsistency in the descriptions of roles, among others.
Despite their nuances, Credentialing and Privileging share the common fundamental goal of upholding superior healthcare standards, ensuring patient safety, and managing risks in clinical settings. However, they are ongoing and dynamic processes requiring regular reassessment and modification as per a practitioner’s performance.
Decoding Credentialing vs. Privileging: The Key Differences
Credentialing, according to the Centers for Medicare and Medicaid Services (CMS), involves the verification and confirmation of a healthcare practitioner’s qualifications or competency. It encompasses an array of activities like checking work history, verifying degrees, confirming current licensure, and conducting background checks.
Conversely, Privileging refers to the authorization given to healthcare practitioners to undertake particular clinical activities based on their skills, experience, and demonstrated capabilities. It’s an essential step defining the procedures that a healthcare professional can execute within a particular medical establishment.
Why Understanding the Distinction Matters
In a metaphorical sense, if Credentialing is akin to mastering the piano and graduating from Juilliard, Privileging is the equivalent of performing at Carnegie Hall. The comparison accentuates the point that while qualifications are crucial, the quality of the actual performance has a more significant bearing on patient experience and, consequently, the hospital’s profitability.
In 2025, healthcare will shift its focus from quantity to quality, or from volume to value, consequently impacting revenue generation. It will consider behavioral, communication, and non-clinical criteria alongside the granted privileges’ clinical criteria. Therefore, designing a system for evaluating and frequently updating privileges, incorporating advanced technologies, and using clear, standardized criteria become imperative in defining future strategies for optimum revenue generation.
If Credentialing is akin to mastering
the piano and graduating from Juilliard, Privileging is the equivalent of performing at Carnegie Hall.
Seizing Future Reimbursement Opportunities
To ready your institution for the prediction of 2025 reimbursement practices, consider the following:
Develop a system to evaluate and frequently update privileges.
Adopt robust digital platforms to spotlight areas for improvement and optimize the Credentialing and Privileging process.
Establish clear, standardized criteria for privileges, and willingly review the content based on outcomes.
Regularly evaluate STAR ratings, contracts, HEDIS, and other ratings, incorporating this data into Credentialing and Privileging assessments to tie criteria to quality outcomes.
Dissecting the Becker's healthcare survey reveals that claim denials, incentives, and penalties will all tie back to performance. It's a healthy reminder that building a successful healthcare institution is contingent on the diligence with which we handle Credentialing and Privileging, thereby ensuring the best care to patients and substantial growth for our organization.
Streamlining Credentialing and Privileging: The Streamline Credify Advantage
Streamline Credify understands the intricacies of health care credentialing. Our innovative solution simplifies this process, making your organization more efficient while maintaining the highest patient care standards. With features like customizable committee review members and automated verifications, we ensure seamless collaboration and faster onboarding.
Shifting to privileging, Streamline Credify's module allows organizations to specify provider privileges, including detailed FPPE and proctoring requirements. Transparency is key; easily viewed privilege breakdowns foster open discussions, while verification and review processes promote informed decision-making rooted in patient safety.
Ultimately, Streamline Credify ensures seamless management of your credentialing and privileging processes, allowing you to prioritize exceptional patient care. Experience the Streamline Credify difference and empower your healthcare organization today!
Joni Orand
Joni Orand, with thirty years of experience in the healthcare industry, has expertise in operations, revenue cycle management, and quality improvement. Holding a degree in Corporate Communications, she is a certified trainer, speaker, and coach, known for delivering impactful presentations and webinars. Based in Gulf Breeze, Florida, Joni owns VIRTCO, LLC, providing consulting services locally and internationally.
