Anytime a physician changes employers or seeks new privileges, they are required to go through the credentialing process. For residents and fellows wrapping up their training, credentialing is one of the first steps to working as a practicing physician.
The process is the verification and assessment of a physician’s education, training and experience. It allows patients to trust that they’re in good hands and physicians to have trust in their peers. Credentialing also plays a part in physician health plan enrollment so that payment for services can be received. For residents, having a knowledge base about the process and how it can be used can go a long way. A recent video—entitled “Physician Credentialing Demystified”—produced by FREIDA offers insight on the process.
“From a resident's perspective, the biggest thing is to know that this process exists—that you need to be prepared for it,” said Tammy Weaver, director of database products at the AMA. “This is a lot of information, and documentation to pull together and fill out.”
Upon accepting a new position, physicians are required to fill out extensive credentialing applications. For residents who anticipate accepting a position in the near future, it’s a good idea to have that information and any supporting documents at the ready.
That information includes:
- Your education, training, and board eligibility or certification
- Your work and medical staff history
- Your clinical privilege history
- Names and emails of peers who can provide reference
- Clinical report cards and performance reviews
- Your malpractice insurance carriers and any claims history
- Explanations for any gaps of 30 days or more in education, training, or work history
- Federal, state, and professional licenses and registrations
It also is helpful to make sure all aspects of your AMA Physician Profile are accurate. The institution with which you are seeking employment may ask for a copy to verify what you provided on your application is accurate.
“The profile contains information that we're obtaining from authoritative (primary) sources such as state license boards, medical schools, training programs, and others,” Weaver said. “We provide this information to expedite the verification process. We also encourage every physician to download their free self-inquiry profile on AMA Profiles Hub because that is the information that a hospital or a payer is going to see when they are out there verifying your information.”
When should you start compiling your information? It is never too early, Weaver said.
“Many residents are exposed to the process while still in training” she said. “But keeping track of your credentials isn’t a one-and-done thing. This really is an ongoing process and physicians benefit from being able to quickly access their most up to date information and documentation.”
Credentialing traditionally sets off a three phase process. The first is credentialing, during which qualifications are verified and assessed. The second is privileging, which gives you permission to perform specific services at the institution based on your credentials. The third is enrollment, which allows you to bill and be paid for those specific services.
Because these processes may take up to 180 days, it’s wise to get started as soon as possible. It’s also imperative that each facet of an application is filled out in full detail.
“You need to make sure you are disclosing everything that there is to disclose, and you need to make sure you're completing 100% of that application,” Weaver said. “That is the most common pitfall and the biggest complaint that we hear from hospitals and practices—that they get incomplete information. And they can't start their process until they get that completed application.”
For residents preparing to enter the job market, the AMA provides many resources to help physicians understand employment contracts, such as the AMA Career Planning Resource and a variety of model contracts e-books (free to AMA members).