Credentialing and Privileging Training Manual
Hello and welcome to the Iris Credentialing and Privileging training manual! We’re glad you’re here. There’s so much to learn about credentialing and privileging, so without further ado, let’s get started.
Chapter 1
Credentialing, Privileging, and Medical Staff Membership Overview
First, let’s define what is meant by credentialing, privileging, and medical staff membership.
Credentialing is the process of obtaining, verifying, and assessing the qualifications of a practitioner to provide care or services in or for a health care organization.
Clinical privileging is the process whereby the individual’s scope of practice is authorized by a health care organization (i.e., authorizes which procedures may be performed and which conditions may be treated), based on an evaluation of credentials and performance. Clinical privileges are granted for a period not to exceed 2 years.
Medical staff membership means that a person is a member of the medical staff (or appointed to the medical staff) and (within hospitals) can call himself a member, attend meetings, vote if in the active category, and receive all other benefits of such membership. There may also be requirements which go along with membership, such as paying dues, attending patients in the emergency department, etc.
TJC: The Who, What, When, and Where’s of Credentialing and Privileging
Wait! All three of these sound like the same thing…
Is there a difference between the terms?
Medical Staff Legal Advisor, February 8, 2005
Hospitals often use the term credentialing to imply a process used to make decisions regarding membership (or appointment) and the granting of privileges. The two terms are, however, quite different.
Technically the term credentialing represents the verification of a person's education, training and experience (as in "to verify a person's credentials"). Hospitals often extend the meaning to include evaluation of collected information and making a decision to appoint a practitioner (as in "he has been credentialed as a member of the staff”). Once the practitioner is fully credentialed and the decision is approved by the Board, they hold a medical staff appointment.
Privileging is completely different. This term implies that a person has been given permission or "privileges" to engage in specified clinical activities. It is important to recognize that the terms membership and privileges are different. Appointing a practitioner to your medical staff does not automatically allow him or her to treat patients. Privileges are needed in order to treat patients. Conversely, practitioners may have privileges but not membership. For example, some medical staffs do not grant membership to non-physician-level practitioners who are Licensed Independent Practitioner
(LIPs), such as Physician Assistant (PAs) and Nurse Practitioners (NPs). Although they are not members of the medical staff, LIPs are granted privileges to render their scope of patient care.
The healthcare facility’s policy/bylaws must outline membership criteria. If the healthcare facility wants the option of granting membership without privileges, their policy must allow this. For example, if a hospital’s membership criteria require members to provide emergency department on-call coverage, the hospital will not have the option of appointing a practitioner to the medical staff without also granting privileges.
In summary, appointment to the medical staff and granting of clinical privileges are part of the credentialing process but are not one in the same, and one must go through the credentialing process to become a member of the medical staff and/or to be granted clinical privileges.
Hold up! Then what does the word “affiliated” mean?
A practitioner is affiliated with any hospital or medical facility where they are currently or were previously credentialed and/or where they currently or previously held privileges.
Categories of Medical Staff
Medical staff categories reflect the type and/or level of practice/activity that a hospital’s or healthcare system’s medical staff members carry out within the facility (e.g., based on the kind/number of admissions, patient contacts, or consultations) and help define their roles in medical staff governance. Each hospital or healthcare facility’s medical staff bylaws should contain a well-defined section on medical staff membership categories and a separate, equally clear article on clinical privileges.
Below is a table outlining common medical staff categories and their corresponding rights and responsibilities.
Categories of Medical Staff (continued)
1. Provisional – initial appointees to the medical staff
2. Active – regularly involved in caring for patients (i.e., admitting, attending, referring, or consulting) to a minimum number of patients a year, as determined by the hospital 3. Courtesy – involved in caring for patients, but to less than the minimum number of patients a year that’s needed to be active staff
4. Affiliate – do not admit or provide clinical services to patients in the hospital; may visit them while they’re inpatient and document in the patient’s medical records
5. Telemedicine – provide diagnostic or treatment services to patients via telemedicine What about Insurance Credentialing?
Physician Practice Specialists
Glad you asked! The term ‘credentialing’ gets used a lot. There is credentialing with the facility (i.e., hospital or clinic) and credentialing with the payors as well (i.e., the insurance companies that the healthcare facility has chosen to accept from their patients). An insurance panel is a group of providers who work with an insurance company to provide services to enrolled clients. The process of getting on an insurance panel is known as getting credentialed. Each insurance company operates its own panel of providers. In order to become a participating provider with an insurance company, the healthcare facility or clinician must get vetted (or credentialed) by the insurance company as part of the enrollment process. The enrollment process starts by making a request to join the insurance company’s network and submitting the provider’s information to them (may include submitting an enrollment application). Once this request has been submitted, the payor will review the provider’s information and determine if they wish to proceed. If they do wish to proceed, the provider will be notified that their application is in process and potentially be asked to submit additional information. This is the credentialing stage where they validate the provider’s information and ensures they are who they say they are. Insurance enrollment is important when the clinic or hospital intends to bill insurance for a clinician’s services. There is typically a credentialing, billing, or payor enrollment specialist at our partner clinics and hospitals who will take on the responsibility of managing the insurance enrollments. Our Iris team members will play a supporting role in getting necessary paperwork and documentation completed promptly. On an as-needed basis, we are also willing to manage the insurance enrollments if our partner clinic or hospital is unable to do so themselves, or requests that we do so.
Synonymous terms: 1) payor enrollment, provider enrollment, insurance enrollment 2) payor, insurance company, insurance panel 3) credentialing, paneling, getting on insurance panels
Got it! So back to healthcare facility credentialing, are there any other terms I should know?
Yes! Here’s a few more to add to your glossary:
Medical Staff shall be divided and referred to as active, part time, provisional, consulting, affiliate, courtesy, allied, locum tenens, temporary physicians and dentists.
Credentialing – remember, this is the vetting of clinicians at the hospital or clinic level. This is where they verify clinicians’ backgrounds and fitness to be on staff. See above for full detail.
Clinical privileging – remember, this is the even more thorough vetting of clinicians (typically at hospitals), to verify clinicians’ fitness to treat patients in their given specialty. See above for full detail.
Recredentialing is the process of periodically reviewing and verifying a clinician’s credentials in order to re privilege and/or reappoint them to the medical staff.
Re-privileging is the review and submission of clinical privileges after initial appointment at biannual intervals to assure that practice limits have not changed and that when conditions change, clinical privileges reflect those changes.
Reappointment is the biannual process of re-evaluating the professional credentials, clinical competence and health status of providers who hold clinical privileges within the facility.
Okay, I get this stuff is important…but why?
As you can see, credentialing and privileging are meant to place a degree of rigor on hospitals and clinics to make sure that when patients come to the doctor, they are getting quality care. There are a variety of organizations that keep tabs on hospitals to make sure they are keeping their standards high. A few of the largest governing organizations are Central Medicare Services (CMS) and the Joint Commission. Hospitals must remain accredited with CMS in order to see the vast majority of Medicare and Medicaid patients. Additionally, hospitals may choose to become Joint Commission accredited which will entitle them to a higher status and potentially better reimbursement from a variety of public and private payors.
Chapter 2
The Elements of Clinician Backgrounds
Now let’s get into the nitty gritty. WHO needs to be credentialed, and WHAT are the elements of their background that need to be vetted?
WHO needs to get credentialed?
An “LIP” is a licensed independent practitioner, defined as an individual, as permitted by law and regulation, and by the organization, to provide care and services without direction or supervision within the scope of the individual’s license and consistent with the privileges granted by the organization. Each state has different laws defining who can practice without supervision. For example, nurse practitioners are licensed in 17 states as “independent practitioners” or, LIP’s; for the remaining states, they are licensed as practicing “under supervision of a LIP.” Bottom line: check your state for which professions are licensed to practice independently. Either way, for Iris Telehealth, we’re talking about MDs/DOs and/or NPs and Licensed Clinical Social Workers (LCSWs).
WHAT are the elements of their background that will be examined? Exams
CMEs /
CEUs
Case Logs
or Clinical
Activity
Report
The above graphic is an example of how the American Medical Association (AMA) delineates physicians’ backgrounds into eight elements. We have also added three elements based on what we commonly see requested as requested in the credentialing process. Each element is described in detail on the following pages.
1. Licensure (current & previous) – most facilities will want to examine all the professional licenses a clinician currently holds or has held in the past. This often includes licenses that are no longer active.
2. Board Certifications
a. ABMS and MOC (Physicians) – The American Board of Medical Specialties (ABMS) allows doctors to further their credentials with a certification in their specialty. ABMS certifications are granted through exams.
i. Beginning January 1, 2012, all certificates are dependent upon continuous maintenance of certification (MOC) based on a three-year cycle of requirements with certificates being valid if they are maintained.
• The examination cycle remains at ten years.
• All ABPN time-limited certificates, regardless of their exact dates of
issuance, are considered to expire on December 31 ten years later.
• Credentialers are encouraged to utilize an annual re-verification date of March 1 in any given year because that’s when the ABPN updates their
verification website.
ii. Physicians certified in psychiatry, child and adolescent psychiatry, neurology, or neurology with special qualification in child neurology before October 1, 1994 were granted lifetime certificates.
b. ANCC, ABNS, & AANP (APRNs) – While the ABMS is specific to MDs and DOs, the American Nurses Credentialing Center (ANCC) and the American Association of Nurse Practitioners (AANP) are the two most common certification bodies for nurses. They provide specialty certifications for registered nurses and advanced practice registered nurses. The most common specialty certification we will look for is the Psychiatric Mental Health Nurse Practitioner (PMHNP) certification. We require it for ALL NPs at Iris.
i. The PMHNP certification examination is only offered by the ANCC.
3. Education – This refers to the medical or nursing degree obtained by the clinician.
a. All MDs/DOs must have proof of completion of their medical or osteopathic degree. For credentialing purposes, a copy or picture of a diploma is usually satisfactory proof, though some facilities will request official transcripts to be mailed directly from the medical school. Transcripts are required by almost ALL medical and nurse licensing boards.
b. Nurses typically obtain an RN license through either an Associate of Science in Nursing degree (ASN) OR through a Bachelor of Science in Nursing (BSN). After an undergraduate nursing degree, individuals can become an Advanced Practice Registered Nurse (APRN) through obtaining a graduate level nursing degree – Master of Nursing program (MSN), Post-Master’s Certificate, etc.
c. Although there are different types of social work licenses, the education requirement for the LCSW credential is a master’s degree in Social Work from a program that is accredited by the Council on Social Work Education (CSWE) in the United States or by the Canadian Association for Social Work Education (CASWE) in Canada.
4. Examinations – these are the licensure exams required for clinicians.
a. Physician Exams (U.S. Graduates and IMGs)
i. United States Medical Licensing Examination® (USMLE®) is a three step (four-part) examination for medical licensure in the United States. The National Board of Medical Examiners (NBME) develops and manages this exam, and co-sponsors the USMLE program with the Federation of State Medical
Boards (FSMB) and ECFMG.
• Step 1: usually taken at the end of the second year of medical school
• Step 2 CK (Clinical Knowledge): usually taken during the fourth year of
medical school
• Step 2 CS (Clinical Skills): usually taken during the fourth year of
medical school
o Added to Step 2 in June 2004 and then became a requirement
of all medical graduates starting with those of a 2005 class
• Step 3 – usually taken after the first year of residency
ii. National Board of Medical Examiners (NBME): The NBME exam was a method of licensure by examination from 1922 to 1994 until it was replaced by the USMLE.
• Deemed equivalent to USMLE steps 1, 2, and 3
iii. Federal Licensing Examination (FLEX): The FLEX was the method of licensure by examination from March 1973 to December 1993 until it was
replaced by the USMLE.
• Deemed equivalent to USMLE steps 1, 2, and 3 and NBME parts 1, 2,
and 3
iv. Comprehensive Osteopathic Medical Licensing Examination of the United States (COMLEX-USA) is an examination series with three levels that serve as pathways for candidates to obtain their osteopathic medical license after graduation. It is the osteopathic equivalent to the USMLE. The National Board of Osteopathic Medical Examiners (NBOME) sponsors the COMLEX USA program.
• Level 2-PE examination was administered on September 23, 2004.
b. Physician Exams (IMGs)
i. Educational Commission on Foreign Medical Graduates (ECFMG) Examination: The ECFMG Examination had been required for all IMGs
seeking entry to residency training and was administered from 1958 to 1984.
ii. Visa-Qualifying Examination (VOE): The VOE was administered to alien IMGs from 1977 to 1984 and was replaced by the FMGEMS.
• Deemed equivalent to the FMGEMS, NBME parts 1 and 2, and USMLE steps 1 and 2
iii. Foreign Medical Graduate Examination in the Medical Sciences (FMGEMS): The FMGEMS replaced the original ECFMG Examination and VOE was administered from 1984 to 1993.
• Deemed equivalent to NBME parts 1 and 2 and USMLE steps 1 and 2
c. ECFMG is a certifying organization built specifically for doctors who graduated medical school outside of the U.S. (i.e., if they’re an international medical graduate (IMG)).
i. Importance of ECFMG Certification
• It’s the standard for evaluating a physician’s qualifications prior to entering a U.S. postgraduate training program.
• It’s a requirement for IMGs to obtain an unrestricted license to practice medicine in the U.S.
• Beginning in June of 2004, the doctor must have taken & passed the USMLE® step 1, step 2 CS, & step 2 CK to become ECFMG-certified (i.e., it’s a requirement for IMGs to take Step 3 of the USMLE).
ii. Eligibility Requirements for ECFMG Certification include satisfying both the medical science examination requirements and clinical skills requirements
• Medical Science Examination Requirement
o Step 1 and Step 2 CK of the USMLE are the exams currently
administered that satisfy the medical science examination
requirement (beginning in June of 2004).
o ECFMG also accepts a passing performance on the following
former examinations to satisfy the medical science examination
requirement for ECFMG Certification: ECFMG Examination,
Visa Qualifying Examination (VQE), Foreign Medical Graduate
Examination in the Medical Sciences (FMGEMS), and the Part I
and Part II Examinations of the National Board of Medical
Examiners (NBME).
o Combinations of exams are also acceptable.
i. Specifically, if you have passed only part of the former
VQE, FMGEMS, or the NBME Part I or Part II, you may
combine a passing performance on the basic medical
science component of one of these exams or USMLE
Step 1 with a passing performance on the clinical
science component of one of the other exams or
USMLE Step 2 CK, provided that the components are
passed within the period specified for the exam
program.
o Additionally, ECFMG accepts a score of 75 or higher on each of
the three days of a single administration of the former
Federation Licensing Examination (FLEX), if taken prior to June
1985, to satisfy this requirement.
• Clinical Skills Requirement
o Step 2 CS of the USMLE is the exam currently administered that
satisfies the clinical skills requirement.
o Step 2 CS replaced the former ECFMG Clinical Skills
Assessment (CSA) effective June 14, 2004.
i. The last administration of the ECFMG CSA took place
on April 16, 2004. When the CSA first started it was
strictly for Foreign Medical Graduates while US
graduates were not required to do it. That was
considered a double standard in the US medical
licensing process. Later the CSA was replaced with the
USMLE step 2 CS and became inclusive to all medical
graduates.
o Level 2 PE of the COMLEX was first administered on
September 23, 2004 and satisfies the clinical skills requirement.
o International medical students/graduates who have both passed
the former ECFMG Clinical Skills Assessment (CSA®) and
achieved a score acceptable to ECFMG on an English language
proficiency test (such as the TOEFL exam or the former
ECFMG English Test) can use these passing performances to
satisfy the clinical skills requirement for ECFMG Certification.
d. The Fifth Pathway was created by the American Medical Association (AMA) in 1971 to allow eligible students to enter U.S. residency training after completing four years of international medical school and supervised clinical work at a U.S. medical school.
i. The USMLE program currently accepts either an ECFMG Certificate or a Fifth Pathway certificate (issued through December 31, 2009) from international medical graduates for purposes of meeting Step 3 eligibility requirements.
ii. The governing committee of the USMLE program and the USMLE parent organizations (the FSMB and NBME) have determined that the USMLE program will cease acceptance of Fifth Pathway certificates for the purpose of meeting Step 3 eligibility requirements, effective January 1, 2017.
iii. Individuals who hold valid Fifth Pathway certificates, and are otherwise eligible, may use their Fifth Pathway certificates to meet Step 3 eligibility requirements, and may apply for Step 3, through December 31, 2016.
e. Nurse Exams
i. National Council Licensure Examination (NCLEX): After successfully completing an accredited nursing degree, nursing students take a standardized exam called the NCLEX. Each state board of nursing uses this exam to
determine whether a candidate is prepared for entry-level nursing practice as a Registered Nurse (RN) if they took the NCLEX-RN or as a Licensed Practical Nurse (LPN) if they took the NCLEX-PN.
ii. State Board Test Pool Exam (SBTPE): This was the licensure examination prior to the NCLEX. When the National Council of State Boards of Nursing (NCSBN) was established in 1978, they took ownership of the SBTPE and
renamed the exam the National Council Licensure Exam (NCLEX) in 1982.
f. LCSW Exams
i. Association of Social Work Boards’ Exam (ASWB): LCSWs take the ASWB Clinical exam once they have been approved by their state, province, or territory.
5. Training – The standard for practicing medicine in the US includes the requirement of “post graduate training.”
a. For MDs/DOs, this refers to training completed after graduating medical/osteopathic school. For most doctors, this means a minimum of four (4) years of residency training in a given specialty (e.g., general medicine, psychiatry, surgery, urology, gynecology, etc.). If a physician wishes to further specialize in a specific age group or type of patient, he/she will need to complete a two (2) year fellowship in this area (e.g., child & adolescent psychiatry, sleep disorders, neo-natal obstetrics). If a doctor knows that he/she will want to complete a fellowship, there are some programs that combine the 4- year residency and 2-year fellowship into a single 5-year program. In this case, the residency is reduced to just 3 years and the fellowship remains a 2-year program. An example we commonly see is a five (5) year Psychiatry + Child & Adolescent Psychiatry program wherein the general psychiatry portion is covered in the first 3 years, and the child & adolescent portion is covered in the following 2 years.
b. For APRNs, residency programs are not required, and their hands-on training is completed during their graduate leveling nursing program through didactic and clinical course work.
i. There are some residency programs available to APRNs and they involve the APRN providing patient care under the supervision of either a physician or
another nurse practitioner while being paid a salary.
c. For LCSWs, in order to apply for a LCSW license, a minimum number of hours of supervised experience is required after they complete their MSW degree. The requirement varies by state.
i. Social work regulations and licensure requirements can be found at the ASWB Social Work Regulation website.
6. DEA Registrations – The Drug Enforcement Agency (DEA), is responsible for regulating clinicians’ prescribing of a variety of “controlled substances.” These drugs can also be referred
to as “schedule drugs,” or “triplicates.” Common classes of these drugs include Opiates and Benzodiazepines (benzos for short). A very common benzo you may have heard of is “Xanax.” In order to prescribe any controlled substances, clinicians must retain a special registration or license to do so. This is called a DEA registration. Though the DEA is a national agency, they have required clinicians to retain a separate DEA registration for EACH state in which they prescribe controlled substances. Iris has quite a few doctors that practice in multiple states. This means – you guessed it—they must retain multiple DEA registrations. Each DEA license includes the clinician’s primary practice address and is thus tied to whichever state that practice is located in. If a physician chooses to stop practicing in one state and start in another, he/she CAN complete a “Change of Address” with the DEA, to reassign that registration to a new state. Each registration costs approximately $731 and lasts for a period of 2 years.
a. Note, you may also come across requests for DPS registrations, suboxone registrations, or other controlled substance certificates. It is important to consult with state licensing board websites and authorities to confirm whether these ancillary registrations are currently required (e.g., Texas DPS registrations have not been in use since 2006).
7. NPI Number – All licensed clinicians (and medical facilities) in the US are granted a National Provider Identifier (NPI) number. This number is utilized by state licensing boards, pharmacies, and medical facilities to identify each unique clinician. This number is registered via the National Plan and Provider Enumeration System (NPPES). The NPPES publishes the parts of the NPI record that have public relevance, including the provider's name, specialty (taxonomy) and practice address. All of this can be found online through a simple google search.
8. State and Federal Sanctions – this is where all those “attestation” questions come into play. State and federal sanctions are records of conflict and resolutions present in a clinician’s history. When a patient or other individual finds a clinician’s behavior or treatment to be problematic, he/she may file a formal complaint to a state medical board or to the DEA. These complaints are addressed and resolved by the state medical boards and records are retained indefinitely.
a. Malpractice or liability claims are not included in the above graphic but are also a KEY factor in clinician backgrounds. By state law, all practicing clinicians are required to hold malpractice or liability insurance. This insurance protects clinicians in the case of procedures or treatment producing problematic outcomes for patients. Should a clinician do something seen as inappropriate or resulting in a problematic outcome, patients or patient families, may choose to file a malpractice claim against a clinician. The insurance companies who cover the clinicians will retain records of all claims filed again the clinician. They will also retain records of the settlement agreed upon. Many hospitals will need to contact the insurance companies directly to confirm a clinician’s record. This is known as their “claims history.”
b. Criminal Background Information: Our Clinical Hiring team is responsible for running a background check on every new clinician, which includes: Social Security Number Trace & Address History, National Criminal Check with County Verification, and National Sex Offender Registry Search.
c. NPDB: A query is a search for information in the NPDB regarding a health care practitioner or organization. The NPDB collects information on medical malpractice
payments and certain adverse actions through reports submitted by entities eligible to report. Hospitals are the only health care entities mandated by federal law to query the NPDB. Organizations must be registered with the NPDB and authorized to query for NPDB information (one-time query vs. continuous query). Our Clinical Hiring team is responsible for enrolling every new clinician in the NPDB continuous query. Clinicians can also run a self-query on themselves (required by some state medical boards during licensing). Healthcare entities receive the following types of information in response to queries:
NPDB HRSA Guidebook
i. Medical malpractice payment information
ii. Licensure actions by boards of medical examiners
iii. Licensing and certification actions taken by states
iv. Federal licensing and certification actions*** (only received by hospitals) v. Adverse actions taken by health care entities against clinical privileges, including professional review actions taken by professional societies
vi. Negative actions or findings by peer review organizations or private accreditation entities
vii. Health care-related criminal convictions
viii. Health care-related civil judgments
ix. Exclusions from participating in federal or state health care programs x. Other health care-related adjudicated actions or decisions
d. Office of Inspector General (OIG): The OIG has the authority to exclude individuals and entities from Federally funded health care programs (and from Medicare and State health care programs). They maintain a list of all currently excluded individuals and entities called the List of Excluded Individuals/Entities (LEIE). Anyone who hires an individual or entity on the LEIE may be subject to civil monetary penalties (CMP). One step in our Iris credentialing workflow is checking the online searchable database.
OIG HHS Exclusions
i. Mandatory exclusions: OIG is required by law to exclude from participation in all Federal health care programs individuals and entities convicted of the following types of criminal offenses: Medicare or Medicaid fraud, as well as any other offenses related to the delivery of items or services under Medicare, Medicaid, SCHIP, or other State health care programs; patient abuse or neglect; felony convictions for other health care-related fraud, theft, or other financial misconduct; and felony convictions relating to unlawful manufacture,
distribution, prescription, or dispensing of controlled substances.
ii. Permissive exclusions: OIG has discretion to exclude individuals and entities on a number of grounds, including (but not limited to) misdemeanor convictions related to health care fraud other than Medicare or a State health program, fraud in a program (other than a health care program) funded by any Federal, State or local government agency; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity; provision of unnecessary or substandard services;
submission of false or fraudulent claims to a Federal health care program;
engaging in unlawful kickback arrangements; defaulting on health education loan or scholarship obligations; and controlling a sanctioned entity as an owner,
officer, or managing employee.
e. Medicare Opt Out Affidavits: Physicians and practitioners who do not wish to enroll in the Medicare program may “opt-out” of Medicare. This means that neither the physician/practitioner, nor the beneficiary submits the bill to Medicare for services rendered. Instead, the beneficiary pays the physician/practitioner out-of-pocket and neither party is reimbursed by Medicare. The physician or practitioner must submit an affidavit to Medicare expressing his/her decision to opt-out of the program. Since most of the healthcare facilities we work with require Medicare enrollment, our eApply includes an attestation question asking whether the clinician is opted out of Medicare and we are responsible for verifying this through the CMS online data set during pre internal credentialing.
CMS Provider Enrollment
i. Opt out periods last for two years and cannot be terminated early unless the physician or practitioner is opting out for the very first time and the affidavit is terminated no later than 90 days after the effective date of the physician or
practitioner’s first opt out period.
9. CME/CE – Continuing Medical Education (CME) or Continuing Education (CE) courses are required by various governing groups such as state licensing boards, specialty certification boards, and hospital/medical facilities to ensure practitioners are maintaining competence and are learning about new and developing areas of their field. Continuing education can be measured in two ways, through continuing education units/credits (CEUs) or contact hours. Although the terms appear to be interchangeable, they are not. They differ in length of time involved in a learning activity and the accrediting organization. One contact hour (CH) is defined as 60 minutes involved in an organized didactic or clinical learning activity. One CEU equals 10 contact hours of participation in an organization continuing education experience. The courses are typically certified by various organizations such as the American Medical Association (AMA), ANCC, ABNS. The continuing education credits can be obtained through various educational outlets such as eLearning websites, universities, webinars, and professional conferences.
See the following website for detailed information regarding the different types of CME credits for physicians: https://www.boardvitals.com/blog/types-of-cme-credits/.
Classroom: CEU-contact-hour
10. Employment/Work History – Healthcare facilities may require a primary source verification from each previous employer. For Iris/internal credentialing, we verify past five years of employment (up to five employers).
11. Hospital Privileges and Medical Staff Appointments – A clinician is affiliated with any hospital or medical facility where they are currently or were previously credentialed and/or where they currently or previously held privileges. For any hospital where a clinician worked, it is necessary to verify whether they had privileges as well as employment at the hospital (the
answer will typically be yes). For Iris/internal credentialing, we verify past five years of privileges and medical staff appointments (up to five hospitals). Note that Locum Tenens and Telemedicine agencies can employ a clinician, but they typically place the clinician in other facilities where they
will be granted privileges to see patients. If a clinician is applying for privileges at a new facility, you will likely need to obtain a record of any and all facilities where they have ever held privileges. Be sure to ask the credentialing specialist at the new facility whether they need a record of all previous privileges or just current ones.
12. Clinical Activity Summary / Patient Log / Case Log / Residency Log – This is a record of patient visits completed or procedures completed (in the case of surgeons). This is requested when a hospital wants to verify that a clinician has met a minimum required number of patient visits while working for a previous employer. This serves as a quantitative piece of data to substantiate the clinician’s workload at a prior job. All requested records should always be deidentified so as not to include a patient name or demographic information. This requirement is rare so note that is may be surprising to the facility when you ask for it. It can often be obtained from the facility’s billing department rather than credentialing or HR department. If the clinician is just out of residency and has no prior work experience, a residency log will be used instead. This is the same thing but is instead produced by the physician’s residency director rather than previous employer. Sometimes a note describing the number of patient visits is all that a facility or residency director can provide.
