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ASC Administrative Overview: Physician Credentialing

Written by Laura Dyrda | February 28, 2014

Credentialing is important for meeting regulatory standards before physicians perform cases at your ambulatory surgery center.

ASCs update physician credentials every year or every other year, depending on state requirements, and collect credentials for new surgeons wanting to perform cases at the center. As much as administrators may want to allow the surgeon who called on Friday to begin that Monday, the appropriate paperwork and background checks must be done.

It often takes 60 to 90 days for surgery centers to collect credentialing material required for surgeons to perform cases at the center. It's possible for ASCs to grant temporary permission for surgeons to begin without all the proper credentials in place, but first ensure these surgeons don't have a high number of adverse events that would put the surgery center at risk, according to a Becker's ASC Review article.

Depending on state and accrediting body policy, the ASC may have different credentialing requirements. However, the physician's office staff should be able to send over current license information. Then it's up to the ASC to verify for accuracy and truthfulness, and ensure information is complete. This might include:

•    Verifying training and education through the American Medical Association or the Educational Commission for Foreign Medical Graduates if the applicant was educated outside the United States
•    Verifying current medical licensure in the state
•    Verifying employment history
•    Verifying Medicare sanction information through the OIG sanctions exclusion database
•    Querying the National Practitioner Data Bank on closed and settled claims history
•    Reviewing any time gaps in education or career (if the applicant has more than a six month period of time when they are not enrolled in a program at a medical teaching institution or employed as a physician, the applicant is asked to provide a detailed explanation on the application)
•    Verifying the status of the applicant's privileges at hospitals and other healthcare facilities as listed on the application

Then examine personal references and determine whether the surgeon is a good fit for the center.

The physicians must have privileges for each procedure performed; if a physician wants to perform a new procedure, there are several steps to take before credentials are issued. The surgeon can formally request privileges if the procedure is on the facility's approved-procedure list. Request documentation showing the physician has been trained in that procedure; you can even request the physician's privileges from affiliated hospitals to double-check experience.

A few tips to make this process easier include:

•    Assign one person to keep track of credentialing; sometimes administrators choose to do this to stay in contact with the surgeons as licenses are renewed.
•    Provide specific instructions to the physician's practice office staff on what is required for privileging, and give them a deadline.
•    Ask the physicians' office secretaries to double-check information before they send it over so it's accurate and everything is filled out correctly.
•    Use an automated system to stay updated on when credentials are expiring.
•    Audit the files so nothing slips through the cracks.
•    Use a checklist to keep track of the processes.

More Articles on Credentialing:
8 Tactics to Strengthen Surgery Center Physician Credentialing

10 Steps to a Thorough Physician Credentialing Process

The Ins and Outs of Medical Staff Credentialing for ASCs


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