Credentialing

What is Physician Credentialing?

Credentialing is the process by which hospitals evaluate and verify the qualifications of physicians to ensure practitioners possess the necessary qualifications. Typically, hospitals verify a physician’s proficiency through the collection, verification and evaluation of data relevant to their professional performance. Minimum credentialing requirements are mandated by law, but hospitals are free to expand upon those requirements. Through credentialing the committee will verify the physician’s medical training, licensure, and history of discipline or medical violations, if any.

Hospitals are required by law to evaluate the competency of physicians administering health care services to patients at their facilities. To conduct these evaluations, hospitals appoint committees, such as a Credentials & Privileges Committee, with the authority to both grant/revoke staff privileges and conduct ongoing evaluations.

Credentialing is often an ongoing process, known as periodic credentialing (i.e. re-credentialing), which allows hospitals to reassess a physician’s competency. This gives the hospital an opportunity to reevaluate physicians’ evolving medical history. Once credentialed, hospitals will take further steps to assess the physician’s competence in specific areas of patient care (e.g. surgery, cardiology) through the process of privileging. Credentialing and privileging requirements should be detailed in the hospital’s medical staff by-laws.

What To Do If You Are Denied Privileges by the Credentialing Committee

Physicians are denied privileges because of something in their background whether, it be medical malpractice, professional license discipline, criminal convictions, or questionable medical education/training. You might have also been denied credentials/privileges because it is alleged that you did not fully disclose all pertinent issues or answered questions in the application correctly.

At times, the credentialing and privileging processes often succumb to political battles at the hospital. As a result, the processes can be used for improper purposes, such as retaliating against physicians. If you are subject to an improper credentialing and privileging process, you should seek legal assistance for an attorney qualified in these matters.

You have the right to be represented by an attorney throughout credentials/privileges processes and you should seek competent representation if you expect to encounter problems. Your rights, often called “due process rights,” are determined by the Medical Staff By-laws at your hospital. You should keep a copy of this document handy and be ready to provide it to your attorney. You can be certain that the Credentials & Privileges Committee is being advised by the hospital’s attorney, so you too should have good legal representation.

Chapman Law Group regularly advises and represents doctors, pharmacists and other practitioners who have been denied hospital credentials/privileges. We urge you to not wait until an investigation against your staff privileges has begun, because your career could be in serious jeopardy. The termination, revocation, or summary suspension of medical staff privileges can lead to reports to the federal National Practitioner Data Bank (NPDB). You should immediately contact a health law attorney for assistance when you learn that there are problems with your credentialing or privileging processes.

How We Help with Credentialing Matters

Chapman Law Group is experienced with representing physicians who are at risk for termination of staff / hospital privileges or are denied credentials (i.e. staff membership). Fair hearing procedures (governed by the hospital’s by-laws) allow you a hearing before a designated panel, like the Credentials & Privileges Committee. Representation by an attorney is extremely helpful to your case because the by-law mandated procedure often allows for the calling of witnesses and the presentation of evidence. If the committee rules against you, Chapman Law Group can assert your appeal rights within the hospital system. The process is very time sensitive and you should be aware of the deadlines in which you have to act.

Chapman Law Group will expertly guide you through the formal appeals process and represent you during the fair hearing process. If you are unsatisfied with the outcome of your credentialing/privileging hearing, Chapman Law Group can also help you consider litigation against the hospital.


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