Individuals who complete medical school are indeed doctors and once they obtain their medical license they are able to see patients in their own practices. However, they are not yet able to serve patients at hospitals. In order for doctors, be it general physicians or specialists, to be able to treat patients and carry out specific medical procedures at hospitals, they must obtain “Hospital Privileges”. These privileges are what authorize a doctor to treat patients at hospitals.
These privileges not only benefit doctors, but are also of great value to the hospitals. The more privileged staff hospitals have on board, the more patients they attract, hence boosting the revenue stream. Moreover, some insurance companies in order to strengthen their brand value by expansion of their network, demand that doctors own these Hospital Privileges if they wish to be empaneled by them.
In general, the doctors can treat patients in multiple practices and hospitals, unless their contract specifically restricts them from doing so as long as they carry the proper privileges. Naturally, highly specialized doctors are fewer in number and, thus, required by multiple hospitals.
Broadly speaking, there are two kinds of Hospital Privileges – Courtesy Privileges and Full Privileges. Under the realm of Courtesy Privileges, physicians are allowed to admit only a limited number of patients at the hospital. Such an agreement is usually adopted by those doctors who do not intend to admit patients at the hospital and carry out medical procedures there themselves. Even though it offers limited rights to physicians, they do satisfy the criteria set by insurance companies for the provider to hold Hospital Privileges. Additionally, physicians are not required to attend medical staff meetings compulsorily under this scheme. Full Privileges, on the other hand, do not restrict physicians on the number of patients they can admit in the hospital. The physicians are granted the full authority to carry out medical procedures in their area of expertise. Physicians with Full Privileges are required to be a part of medical staff meetings.
The procedure that finally results in physicians obtaining these privileges begins with the doctor deciding to work at a hospital. The doctor initiates the process by contacting the hospital expressing her/his interest in working there. An application detailing information about the doctor’s background, education and qualifications, professional medical experience, licenses, medical liability insurance along with key references is submitted by the doctor. In this application the doctor must also specify their field of specialization and where they would like to practice. The next step in the process involves verification of the application submitted by the doctor. Upon verification, the application goes through several rounds of review with the relevant departments, Credentials Committee, Medical executive committee and the Board of Directors. The various committees provide their verdict on membership and privileges. However, the final decision of granting the privileges rests in the hands of the Board of Directors. Finally, based on the doctor’s profile and application, the Board may choose to grant full, limited or no privileges to the doctor.
The reasons behind denial of privileges may be manifold. They could include one or more reasons such as incomplete training or lack of experience, exclusion from Federal healthcare programs such as Medicare and Medicaid, fraud or abusive practices leading to loss of medical licenses. Doctors who treat an insufficient number of patients over a period of time are not favored by hospitals when it comes to granting privileges for business reasons.
Consulting with an external organization that specializes in provider profile management and all paperwork related to healthcare providers, might be a blessing on several counts. CredAxis is one such organization that understands the rules and regulations across various states in the country, and is positioned to educate and guide providers when it comes to contract management and hospital privileging. The experts at CredAxis can guide physicians on to how to go about choosing the hospitals best suited to their profile, specialization and other circumstances.
The initial phase of Privileging is credentialing, which the hospital utilizes to gauge if the physician is a good fit for their needs. CredAxis is the prime service provider for this service. CredAxis can take care of all forms, phone calls and paperwork related to Hospital Privileges. They will also make all the follow ups on the application on behalf of the providers. They also send out timely reminders to prevent providers from losing their privileges. Get in touch with CredAxis now and simplify all your administrative processes.