Healthcare Credentialing: Your Background Screening Check-up
Understanding candidate credentials is a core part of a complete healthcare background check. It helps you understand the capabilities of individuals who may join your workforce.
Credential checks inform you of the licenses, education, and certifications candidates possess, so you can make well-informed hiring decisions. After hire, credentialing also provides you with deeper insights into the capabilities of your employees, so you can understand your workforce better.
The Importance of Healthcare Credentialing
As an essential element of background screening, healthcare credentialing tells you the degree to which candidates and employees possess the education, training, and knowledge to perform their role successfully. Credentialing also supports your commitment to exceptional patient care. It weeds out practitioners who don’t possess the necessary qualifications to treat patients.
Without thorough credentialing, you can risk exposing patients to individuals who could cause harm. In Florida, a teenager without medical credentials gained patient access in an area hospital. Though he claimed to have surgery qualifications, he possessed no licenses to practice surgery.
Credentialing also helps you determine whether candidates possess the required credentials for specific kinds of work. For example, a physician with a medical degree may not be licensed to perform surgery, but they may be licensed to perform radiology functions such as catheterization. Credentialing helps you verify how well-matched candidates will be to specific roles, and whether or not they meet the qualifications spelled out in your policies.
Comprehensive healthcare credentialing requires checking for medical licenses and certifications so your organization can stay in compliance with healthcare background screening laws, as well as specific state requirements for practicing medicine. With a thorough credentialing process in place, you can also maintain a healthy accreditation record and stay aligned with Joint Commission guidelines for checking credentials.
Top 4 Healthcare Credential Areas to Check in Background Screening
Given the proliferation of diploma mills and fake degrees, it’s critical to work with a background screening provider who uses best-in-class screening technology to deliver quality healthcare credential verification. Your credentialing process should include verifications of the following credentials for your healthcare hires:
Graduate and post-graduate education
Positions such as physician assistants and administrative management roles may require a bachelor’s degree, whereas physicians and medical specialists require a medical degree. However, just any degree from any institution doesn’t automatically qualify a candidate for employment. By conducting thorough education verifications, you learn whether candidates possess degrees from accredited, reputable colleges and universities.
Some healthcare professions can be performed without a medical degree, for example, technicians and medical assistants. Credentialing for these hires requires verifying their certifications are current. Since certifications can expire or require recertification after a specific period of time, your background screening process should include certification checks before and during employment.
Before and during employment, you will need to check medical license status for each physician, nurse, and other licensed hire. Licensing requirements vary by state, so you’ll also need to confirm each candidate possesses the necessary licenses for the hiring location.
Using an inadequate credentialing process can allow unlicensed practitioners to slip through the cracks and expose your organization to reputational risk or possible lawsuits. One Tennessee woman worked fraudulently as a nurse for at least eight healthcare providers over six years, though she did not possess a nursing degree or license. One of the providers who employed her claimed a loss of $500,000 due to her negligence.
Per requirements from regulatory agencies such as the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS), healthcare organizations must avoid hiring or employing anyone with healthcare employment sanctions or exclusions, or risk penalties such as fines and lawsuits. Check the following lists to be sure you don’t employ anyone prohibited from healthcare employment:
- HHS Office of Inspector General (OIG) List of Excluded Individuals and Entities (LEIE): Lists individuals excluded from working for healthcare organizations that receive federal funding
- U.S. General Services Administration (GSA) System for Award Management (SAM): Lists individuals and firms barred from receiving federal contracts or subcontracts
- Healthcare Fraud and Abuse Lists: Provide individual sanction histories using data from federal agencies and over 800 licensing and certification agencies across 50 states
- National Practitioner Data Bank (NPDB): Contains reports on medical malpractice payments and other adverse actions taken against health care practitioners and suppliers
- Global Sanctions and Watch List: Includes individuals named as national security threats by the Patriot Act
- State-Specific Exclusion Lists: Provide information about individuals barred from healthcare employment in specific states
Different Methods for Credential Screening
Healthcare employers are required by law to conduct background screening for prospective employees. You must also avoid employing individuals who lack the necessary credentials for active employment. Therefore, to stay in compliance and protect your patients and workplace from harm, you need a process for conducting credential checks before and after hire. Available healthcare credentialing options include the following:
The initial pre-hire background check is your first opportunity to verify candidate qualifications and licenses. Checking credentials at this stage helps you stay in compliance, and it denies prospective employees who lack the necessary medical degrees, certifications, or licenses access to patients.
Intermittent workforce monitoring
The HHS OIG requires healthcare employers to check exclusion and sanction lists routinely for employee names. Intermittent workforce monitoring for license activity and sanctions is typically conducted on a predetermined basis, for example, monthly. While monthly routine checks for license suspensions or other disciplinary action is better than nothing at all, it can still lead to delays and gaps in your workforce monitoring activities. Using this option, you may not know about an employee who received employment sanctions until weeks after a ruling or judgment by a regulatory body.
On an ongoing basis, continuous monitoring allows you to confirm whether your employees continue to possess the necessary credentials to work in your organization. With the help of cutting-edge technology and support from your background screening provider, you get up-to-the-minute updates on any changes affecting employment sanctions, disciplinary action, or employment exclusions. The continuous nature of this screening solution gives you greater visibility of your workforce than intermittent monitoring, while also helping to position your organization for better compliance with OIG requirements.
Give Your Credentialing Program a Clean Bill of Health with Continuous Monitoring
Not all background check and credentialing processes are the same, nor do they provide the same level of protection to help you maintain a safe patient environment. Continuous monitoring picks up where your pre-hire background check left off, providing you with uninterrupted sanction monitoring and credentialing for your workforce.
Given the broad range of medical degrees, licenses, and certifications your workforce possesses, you need immediate notification of license activity or sanctions requiring action. A continuous solution provides the benefits of real-time monitoring so you can sidestep delays and protect your patients and workplace around the clock. To learn more about ways to improve the compliance and well-being of your background check program, read our Healthcare Background Screening Compliance Checklist.