Credentialing

Trauma Columnist · Mar 18, 2017

Are you working in a hospital or private practice office? If hospital, yes you need to be credentialed and at least in my area (I'm credentialed at 3 hospital systems), credentialing can take up to 6 months as it depends on how often the hospital credentialing board meets for mid-level providers.

If private practice, don't they have a clerk to do this?

Bumex, DNP, NP · Mar 19, 2017

I'm currently dealing with this right now. The credentialing process at long term acute care centers has taken 2 months and the acute care hospitals are still pending. The SNFs are either immediate or 1-2 weeks.

to answer your question- yes you need to become credentialed.

TicTok411 · Mar 19, 2017

My credentialing took about three months. I think they also deal with getting you covered by medicare and all the insurance plans so you can be reimbursed for patients you see. So, it is kind of important and something we all go thru... It also makes it tougher to job hop as the process takes so long.

Xcbanditbravo · Mar 20, 2017

I understand it's something I'll need. But can I see patients and rx meds then bill under MD who is in office. Also isn't there a period of time I can hold billing and bill after insurances credential me?

elkpark · Mar 20, 2017

I understand it's something I'll need. But can I see patients and rx meds then bill under MD who is in office. Also isn't there a period of time I can hold billing and bill after insurances credential me?

If you're talking about seeing people in a hospital and billing under the physician in the office, the hospitals for which I've worked in the past just won't allow you to come into the hospital and see people, regardless of who is or isn't billing, until you've been credentialed. I got hired as a psych CNS to work for the psych C&L service that is contracted to provide services in several of our local hospitals, and I still had to go through the separate credentialing process for each of the hospitals in the system in which we consult.

Advanced Practice Columnist / Guide · Mar 21, 2017

I understand it's something I'll need. But can I see patients and rx meds then bill under MD who is in office. Also isn't there a period of time I can hold billing and bill after insurances credential me?

If you're practicing in an in-patient setting, hospitals won't let you see patients and order anything without being credentialed as a provider. In some places, they may say you can function as an RN if you're not credentialed yet. That means you can only see patients as a scribe (i.e., on your notes, you are not documenting physical exam, assessment and plan) and write your orders as a verbal order from the physician you work with. Without the ability to see patients as a provider, you can't bill for services as a provider.

flipper628 · Mar 28, 2017

Currently awaiting for the whole credentialing process to be completed as well. They let me start working and I am basically just shadowing the MD. I'm really learning alot, but feel like I'm useless. They won't even give me computer access where I can at least see patients and complete a note and have the doc sign off on it. I wish I could help more.

Trauma Columnist · Mar 29, 2017

Credentialing is a must in order for you to be accountable to both your practice/facility as well as to the insurance companies. Its a necessary evil and really no way to circumvent it. In our area, hospitals are fairly quick about it - that is 2-3 months. Other clinics or other entities can take up to 5-6 months.

Use this time shadowing to ask questions, ask what specialty books are recommended, learn who to go to for what request, put phone numbers in your phone as well as obtaining all contact info needed, start to network with your peers. You want to make this time the most productive that you can as it won't be long before you will be on your own.

chiromed0 · Apr 6, 2017

I'm still a little confused by the term "credentialed" when speaking of hospitals vs insurance companies. As I understand it all it means is "verified" and approved by someone or some committee. So in the clinical setting what they mean would be you can't see patients b/c we can't bill for you seeing them. If they want to pay cash then that's a different story. Or if the physician is "on site" then they can still bill under the physician's name b/c they are signing off on your charts for the day. In the hospital you can't "practice" as an NP until they say you can which is their "credentialing department and committee" meet and vote "Yay" to get you in the club. Now, having said that (if I'm correct) I can't for the life of me understand why the hospitals take soooooooooo loooonnnnnnggggg to do pretty much the same exact thing a smaller clinic does in checking out your licenses, certs, background, etc. I got a job at the world famous "ebola hospital" but ended up taking a job with a clinic chain due to commute AND an extra long credentialing process that was dragging out 5-6 months! I was a new NP without any history to credential! I'd hate to see what happened if there was a lot to verify. Anyway, I feel your pain and stand corrected if what I've said is incomplete or wrong.

Purrsx2 · May 14, 2017

I started working in the end of February for an outpatient ENT clinic of a large teaching facility. It is mid-May and I am still waiting to be credentialed... I am seeing patients, diagnosing, prescribing and referring, but I pend all prescriptions to be signed by MD and he puts attestation on every SOAP note of mine and all services are billed under his name. I was explained that I cannot see patients and bill until the credentialing process is completed. I am not sure if it means credentialed by that large teaching facility or by Medicare, Medicaid and every major and minor insurance company out there, but I am still patiently waiting. While the surgeon was on vacations, I was not allowed to see patients since those visits could not have been billed under his name. So I just sat in the office for 2 days and read ENT books and did some research for a couple of complicated medical cases he told me to figure out (did a good job on that, so when he came back we changed their Tx plan based on my recommendations). I still got paid for those 2 days, which was nice, but it was kind of weird just sitting there in an empty office full of support stuff (2 LPNs, receptionist, surgical scheduler and office manager).