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Stephen O'Connor

By: Stephen O'Connor on February 4th, 2021

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What Is Medical Credentialing, and Why Is it Important?

Healthcare Advice | Medical Practice

Medical credentialing verifies that nurses and doctors are properly trained and certified and have the required professional experience to provide healthcare services to patients. It’s a crucial aspect of maintaining high standards of safety in the medical profession.

From a financial perspective, organizations typically cannot obtain reimbursement for provided services from insurance entities including Medicaid/Medicare if they lack medical credentialing.

Without medical credentialing, it can be extremely difficult to work with any healthcare software solutions. No forward-looking medical practice or healthcare provider can ignore medical credentialing and expect to thrive in this industry.

As Healthcare Innovation reported, “Medical credentialing is increasingly important because it is the one procedure that allows patients to confidently place their trust in their chosen healthcare providers.”

Since medical credentialing is the process that lets us know doctors and nurses have proper training and experience to practice the healing arts, it’s incumbent on healthcare organizations to have a good understanding of medical credentialing.

The process of medical credentialing began as far back as 1,000 BC, when the Cult of Zoroaster mandated that physicians treat three heretics. If all three lived, the doctor would be qualified to treat patients until the end of his or her career, according to Continuum. We’ve come a long way since the method used to credential doctors in ancient Persia, but the underlying theory is the same: To make sure medical professionals are qualified to treat patients.

To help you address this topic with your colleagues, here are five reasons why practices need to have medical credentialing and why it is so important.

1. Instills Confidence in Patients

The state of mind of your patients plays a big role in the healing process. Patients who trust their physicians can feel better about following doctor’s orders, from making changes in diet and exercise to trying a new medication or undergoing a procedure. Of course, patients who are confident in their doctors are also going to be more likely to stay with the practice and won’t be looking around for a more competent physician.

By the same token, having fully medically credentialed nurses and doctors makes your organization more appealing to other employees, from new physicians, PAs, LVNs, RNs and nurse practitioners as well as the support staff. They’ll want the prestige that comes from knowing colleagues are all well-trained and up to speed on the latest in the medical industry. You encourage future excellence by highlighting the current outstanding abilities of your team.

2. Establishes Your Professionalism

It’s in your best interest to demonstrate your professionalism in a healthcare setting, with irrefutable documentation. Taking the time to fill out paperwork required to show your credentials is a small price to pay for being able to assure patients of your bona fides.

Healthcare Innovation noted, “Through a standardized process involving data collection, primary source verification and committee review by health plans, hospitals and other healthcare agencies, patients are assured of their healthcare professional's merit and experience.”

In the past, medical professionals may have balked at the process of credentialing, because of all the paperwork they’d have to wade through. But modern methods allow for much of this information to be dealt with online. Check that your team can use electronic credentialing for any entities that want to check your standing, such as before you start a contract with another organization or before any hospital can allow you to become an affiliate.

Details to provide include where you went to medical school and the location of your internship or residency, your board certifications as well as your curriculum vitae. Of course, you’ll also note information about malpractice insurance that you carry as well as your current, valid medical license.

3. Required for Compensation

You’ll need to be medically credentialed, as this is required for reimbursement from insurance companies. Getting the documentation finished promptly ensures that a new nurse or doctor you’ve hired can actually begin providing services on hiring day.

To that end, many organizations will require applicants to have their documentation set up well ahead of time. It’s not a task to put off, and the time frame can vary from state to state because of differences in regulations and credentialing laws.

Private health insurance companies as well as Medicare and Medicaid will want to see proof of medical credentialing before you can allow your staff to engage with patients.

4. Cuts Down on Medical Errors

When healthcare professionals obtain proper medical credentials, it helps to support the safety and security of the entire industry. 

With medical errors being implicated in 98,000 deaths in America (per Healthcare Innovation’s report), the importance of medical credentialing becomes clearer. Patients have a right to trust that their healthcare providers know what they’re doing and are working in a safe and approved fashion.

5. Ensures You Have Adequate Staff Levels

If you’ve been having problems maintaining the requisite staff levels to serve your local community, medical credentialing is an important aspect of filling out your team. 

New medical staff candidates who aren’t coming from a job placement company (that would help them with credentialing) should get started with medical credentialing as early as possible. It could take as many as four months to complete. To help pave the way, create resources such as a credentialing packet to give to all new hires. It will support them through the application process.

Your human resources department would be well advised to track the status of medical credentialing of all candidates, to identify any obstacles that could delay onboarding new hires.

Ensure Medical Credentialing Doesn’t Slow Down Your Practice

If it’s been a while since you’ve considered the issue of medical credentialing or raised it among staffers in your medical organization, think of what other important healthcare topics you also may be neglecting to think about.

Staying informed on current events and the latest in medical industry best practices is a goal you may have difficulty meeting, given how busy you and your staff are. No worries. We’ve got you covered with ongoing coverage of healthcare industry matter that directly affect you and your team. Stay up-to-date by subscribing to the blog now.


About Stephen O'Connor

Stephen O'Connor is the Director of Brand and Digital Marketing, responsible for many aspects of Advanced Data Systems Corporation’s (ADS) marketing, including product marketing, customer acquisition, demand generation, brand, brand design, and content marketing.

Stephen has more than 20 years of healthcare industry experience. Prior to ADS, Stephen spent 11 years at Medical Resources Inc. (MRI), most recently as the Manager of Marketing & Internet Services, where he and his teams were responsible for all marketing efforts and the market positioning of MRI’s services.

Stephen spends his day's planning, writing, & designing resources for the modern healthcare professional.