Russian Healthcare

Professional Liability and Negligent Credentialing

Ann Klinger

DeVry University

HSM320 Health Rights and Responsibilities Application Paper #1

Scarlett Lusk

May 24, 2012

Protecting Patients Via Credentialing

Executive Summary

Before a patient can see a practitioner (physician, nurse practitioner, physician assistant) in either a hospital, or under a health insurance plan, the practitioner’s credentials must be verified. This paper will review how following credentialing standards in a hospital setting can help to protect patients and prevent a Credentialer (for example Credentialing Specialist or Medical Staff Coordinator) from being pulled into a negligent credentialing lawsuit. Many hospitals are governed by The Joint Commission (TJC) (formerly Joint Commission on Accreditation of Healthcare Organizations - JCAHO), Centers for Medicare and Medicaid (CMS) or other accreditation organizations, which have standards and guidelines that must be met as part of the credentialing and privileging process. The credentialing process is used to evaluate and verify a practitioner’s education, training, medical licenses, malpractice history and affiliations with other hospitals and clinics.

Before a practitioner is granted privileges (the ability to perform procedures or touch a patient), or membership at a hospital the credentialing process must be completed. The process starts with the practitioner completing an application and other required documents for membership and privileges. Upon receipt of the application the Credentialer will begin the credentialing process.

The Credentialing and Privileging Process

The credentialing process (or initial appointment process) varies from facilities, but usually involves the following steps. :

• Verifying all levels of medical training and education starting with medical school. This includes residency and internships and even fellowships.

• If a foreign medical graduate, then verification of...