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INTRODUCTION

The next step in your employment process may require you to apply for healthcare system credentialing and privileging. This process is also part of the employment on-boarding for all hospital-based practitioners. The US Department of Health and Human Services definition for credentialing is “the process of assessing and confirming the qualifications of a licensed or certified health care provider.”1 The Joint Commission defines credentialing as “the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization.”2

Credentialing is the first step to vet a provider for hospital practice. Credentialing for privileges is essential to ensure those providing services are qualified to do so. Over time, this process has become complicated due to the expansion of providers’ scopes of practice, the requirements of third-party payers (e.g., the US government and private health insurance plans), and organizational standards of various accrediting bodies such as the Joint Commission.

Credentialing is a partner to privileging. Privileging is the process of authorizing a licensed or certified healthcare practitioner’s specific scope of patient care services or scope of practice. Privileging is often performed in conjunction with an evaluation of an individual’s clinical qualifications and/or performance.3

Hospital credentialing is required if your role requires you to see patients in the hospital setting or affiliated practices as part of your employment contract. Some of the managed care plans require their primary care providers to have hospital admitting privileges. In this instance you will be required to apply for privileges. This process is similar for all medical providers and is a requirement of the Joint Commission.4

Federal law requires that all hospitalized patients covered by Medicare must be under the care of a physician as a licensed doctor of medicine, osteopathy, dental surgery or dental medicine, podiatric medicine, chiropractic, or optometry.5 After a 1994 amendment was made to the Social Security Act to change federal Medicare law, clinical psychologists were added to the list of providers who may care for hospitalized patients.5 An additional federal regulation allows physicians to “delegate tasks to other qualified healthcare personnel to the extent recognized under state law or a state’s regulatory mechanism.” It’s this delegation regulation that NPs who deliver care to hospitalized patients fall under. While an NP may have admitting privileges, there must be a physician’s name on the patient’s record as “attending,” in order to be compliant with this federal law.6

There are different levels of privileges that hospitals may assign to providers. Associate or affiliate staff privileges are often those granted to NPs. Associate/affiliate staff privileges are not full privileges. There are various limitations that can be imposed on providers with associate/affiliate staff privileges. Medical staff bylaws can also limit scope of practice for NP providers even if the privilege requested is within the ...

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