The Administrative Process: Credentialing, Privileges, and Maintenance of Certification

Abstract

Many times the processes of credentialing, privileging, and maintenance of certification are confused or combined into one concept by the advanced care provider. They are three distinct processes that are interrelated. All of these processes are necessary for the advanced care practitioner to understand as they relate directly to the ability to provide care to patients in an institution or healthcare organization. Credentialing is a formal process that has both internal and external regulatory requirements for reviewing the “credentials” of an applicant for clinical appointment within an institution or practice. This process is governed by internal policy, state law, external regulation, and accreditation requirements. Privileging is an internal process used by institutions and practices to define and approve clinical activity. This process is governed by internal policy and is referenced by state law, external regulators, and accreditation agencies. Unlike credentialing, the process for privileging is completely at the discretion of the institution or practice. Maintenance of certification (MOC) is a process in which individual clinicians complete certain training, education, performance improvement, and self-assessment activities in order to keep certification from state or national certification agencies. This typically includes a formal examination of medical knowledge, patient care, ethics, and regulatory knowledge. It is crucial that clinicians have an understanding of these processes and comply with requests for information, documentation, and professional references, as well as meet any training or education requirements as indicated by the institution or practice.