Introduction to the Business of Medicine: Physician Licensure, Credentials, and Privileges

Beckie Herron , MA, CPCS Director of Credentials Verification at Baptist Health System KY & IN , and Dr Brad Housman , Vice President & Chief Medical Officer at Baptist Health Paducah, discuss the essential steps physicians must take to obtain licensure, credentials, hospital/facility privileges, and payer enrollment. Baptist Health Medical Group is an AMA Health System Member.

Transcript available below. Claim CME here.

Resources For Organizations:

Resources For Individual Physicians:

The Interstate Medical Licensure Compact at https://imlcc.com.

The CAQH provider page at https://www.caqh.org/providers

Speaker: Hello and welcome to the AMA STEPS Forward® podcast series. We'll hear from health care leaders nationwide about real-world solutions to the challenges that practices are confronting today, solutions that help put the joy back into medicine. AMA's STEPS Forward program is open access and free to all at STEPSForward.org.

Sea Chen , MD: Hello, and welcome to this episode of the AMA STEPS Forward podcast series. This is your co-host, Dr Sea Chen, Physician Director of Practice Sustainability here at the AMA.

Taylor Johnson MBA : And I'm your other co-host, Taylor Johnson, Manager of Physician Practice Development at the AMA with Dr Chen.

Dr Chen: After a physician accepts a new job, whether it be right after finishing training or as a career transition, we go through the credentialing process at our new organization so we can start taking care of patients.

Johnson: There is a short video produced by the FREIDA™ team here at the AMA, which introduces this process at a high level. If you haven't already seen the video, please pause the podcast and click on the link in the episode description to get a quick overview. To discuss the credentialing process in a bit more detail, we're joined by our guests, Dr Brad Housman, Vice President and Chief Medical Officer at Baptist Health in Kentucky, and Beckie Herron, the Director of Credentials Verification, also at Baptist Health. Thank you both so much for being here today.

Brad Housman , MD: Thank you for having us.

Beckie Herron : Yes, thank you.

Dr Chen: Before we get started diving into the topic, would you mind telling our listeners a little bit more about yourselves and your background? Dr Housman, would you like to start?

Dr Housman: Certainly. Thank you. So my name is Dr Brad Housman. I'm Vice President, Chief Medical Officer at Baptist Health Paducah. Baptist Health System KY & IN is a health care system primarily in the state of Kentucky, but we also have a facility in Southern Indiana. And I'm one of the CMOs at one of the local facilities.

In addition to that responsibility, a number of years ago, I was asked, on behalf of the system, to get a little bit more involved in credentialing and privileging, specifically looking at setting up a CVO for our system, a centralized credentialing verification office. And so, we embarked on that journey a number of years ago, and are super fortunate to have Beckie Herron as our director of the CVO.

Dr Chen: Wonderful. Beckie, could you tell us a little bit more about yourself?

Herron: Yeah. Hello, and thank you so much for having me. I am Beckie Herron, Director of Credentials Verification for Baptist Health System . I've been in my current role for about 2 and a half years when, as Dr Housman said, Baptist made the impactful decision to centralize hospital medical staff credentialing across the system. Therefore, hopefully, we're improving physician-facing application processes too. Prior to that, I was the director of medical staff services at 2 Baptist facilities for over 7 and a half years. So I've been at Baptist total for 10 years.

I've been a medical staff professional in the credentialing field, both hospital and managed care, for 25 years and in the health care field working with physicians for over 30 years.

Johnson: That's great. Before we get into the details of the credentialing process, I was hoping we could first talk a bit about state licensure and specifically, what do you tell newly graduated physicians or physicians coming from out of state who need to obtain their state licenses and possibly a controlled substance registration?

Herron: The best thing to do is apply as soon as possible. Each state has different licensing processes and requirements. The timing, you know, they have, some of the boards meet monthly, some quarterly. Most do offer temporary licenses, but not all, and not all hospital bylaws will allow temporary licenses, so it's also different at each hospital.

Some organizations require a valid state license before you can even start the application process for privileges. So I think the most important thing to do is apply as soon as possible, and the physician has to stay on the state license and constantly contact them. Is there anything you need? You know, what, what do you need from me? What can I do to make this process go? Because the, the states have only so many people that process applications. So they, if they can help them in any way, and if there's anything they're missing, produce that information so that they can get their license as soon as possible.

Dr Housman: Yeah, I would echo those comments by Beckie and fortunately, at least in the state of Kentucky, state licensure process is, is reasonably efficient, but especially for new physicians that are coming out of residency or training, I think that they should at least mentally be thinking about applying for a state license by January of the year that they're going to finish if they're anticipating a summer start. So hopefully it won't take 3 to 6 months to get that state license. But that's certainly not too far in advance If you've already made your decisions about where you're going to want to practice after you finish your training, it's imperative to get that process started because as Beckie mentioned you're a little bit at the mercy of when the boards meet. And so we have to work with that.

Dr Chen: I've heard a little bit about this licensure compact, the IMLCC. Beckie, do you have any more information for our listeners about this program?

Herron: Yeah, the Interstate Medical License Compact is agreement that allows the states to work together to streamline the licensing process. It creates an expedited pathway to a physician who wants to practice in multiple states. However, the license is still issued by the individual state. I think it's just a more streamlined process if you're coming from another state.

Johnson: So I know we're talking about the state licensure. Is there anything specific or I guess different that the physicians should be aware of or anticipate when we're talking DEA license, or their NPI numbers?

Herron: Yes, the NPI actually doesn't take horribly long. It's like an online 15-minute, 20-minute process. It takes about 1 to 2 weeks. The average is about 10 days. So, you know, it's not as vital to get that part going before licensure. You do have to make sure when you're applying for licensure, they don't already require an NPI. Most of them don't require a DEA before you get licensed, but some might require an NPI. But like I said, it's not as hard a process or as lengthy a process and it's online. The federal DEA can take 6 to 8 weeks, but that's also dependent on the state. There's 23 states that have a, a state CDS or controlled substance. And I'll give you an example, Indiana, because we work in Indiana as well, you have to have your Indiana controlled substance before you can apply for your federal DEA. And you have to have an Indiana license before you can apply for your Indiana Controlled Substance. So it's, it's like you're sometimes waiting on the DEA and the Controlled Substance longer than license now, but DEA, apply as soon as possible, but also be aware of the state license requirements.

Dr Chen: Thanks for all that information. Now that we've talked a little bit about state licensure, I wanted to get more into the meat of the actual credentialing process. The FREIDA video we talked about in the intro describes three steps to this process. Credentialing, privileging, and enrollment. I think we'll discuss each of these steps in detail, but first, Dr Housman, could you tell us at a high level how these steps play out at your institution and how they're kind of interconnected with each other?

Dr Housman: Certainly. So as you mentioned, each of these steps or subdivisions, if you will, kind of work hand in hand, but quite simply, the way I approach it and the way I've described it to other folks is that credentialing is the process of, of us proving you are who you say you are, and I'm sure we're going to talk about that in a few minutes. Some of the documents that are required to establish that, yes, you're a physician or a provider, you've done the training that you say you have done, so we've established that. Privileging, then, is usually the portion of the process that takes place at the local facility, where we evaluate the type of things, the type of medicine, or the type of procedures that you want to practice or perform, and we establish that you're trained to do that. So, part 1 is you are who you say you are. Part 2, you can do the things you say you can do. And then the payer credentialing is sometimes the part we forget about, or that's less on the provider's mind, but it's an equally important part of the business of medicine. That's the part where you get paid for the work that you do. So it's, if you want to think of it kind of like a 3-legged stool, those are the 3 big areas or 3 big buckets.

As was already mentioned in our discussion, privileging is still a local individual function. It's up to each hospital's credentials committee to look at the application and look at the applicant and consider the privileges that are being requested, make sure those privileges are within the capability of that facility, and make sure they're appropriate for that community.

So that's the local piece that you still have to take into consideration as you're going through the process. And then the last part again, that's a little bit out of our control is when you apply to the payers and become certified with them so that you can bill, say, insurance, Medicare, Medicaid, those sorts of things.

Dr Chen: Great. Beckie, I think Dr Housman has really outlined well the interconnectedness. Are there any common errors or roadblocks, especially in between these steps that come into play when a physician is going through this process?

Herron: I think for credentialing, the biggest roadblock is having all of the correct contact information entered on the application and everything entered thoroughly and completely.

The more information that they have copies of PDFs in electronic format before they start their application, the better. So just, not to hold up the whole credentialing process, you know, because there's a workflow that each CVO or MSO, medical staff office, goes through and they're going to say, OK, we need these 100 things and then just making sure they don't have everything to get back as soon as possible. Things like that. There should be people to help them with that. For privileging, just make sure the physician needs to review the privilege form thoroughly and know what they need to request and have the appropriate case logs and the required number gathered ahead of time. Provider enrollment that requires numerous documents and gathering that ahead of time and provider enrollment is a lot of numbers that you'll need to have, like your NPI, etc, and similar documents to credentialing but they're not always the same. They sometimes ask for more like an example is they'll ask for a social security card to get Kentucky Medicaid. It's antiquated, you don't want to release your social security card because of, you know, fraud, but in order to get Kentucky Medicaid number you're going to have to, so that's just kind of an example. We don't need it in credentialing, but provider enrollment needs it.

Dr Chen: Got it. And are there any different steps between those physicians that are employed versus those that are independent, but aligned with your system?

Herron: For legal and compliance purposes, it's important the credentialing process be applied uniformly to all physicians, whether they're employed or independent. There may be a different workflow to start the process, but the information gathered and how it's verified should be equal. It's, it's just a different workflow, but it's all the same information, whether they're employed or not, basically.

Johnson: Awesome. So I want to dive a little further into the credentials verification process. So Beckie, can you tell our listeners what kinds of documents and data need to be provided and how that data is verified? I know you touched on this a little bit, but if we could go into more detail.

Herron: Yes, there are, like I said, probably 100 line items on our workflow, so there's many, many things that we need to request.

I'm not going to list every single one of them, but the main things are, as far as documents go, copies of education and training certificates are helpful. Provider enrollment is going to need that for sure. Copies of DEA, copies of life safety certifications like your BLS and ACLS. Now those are specialty and hospital-dependent, your life safety certifications, but if a physician has those, those should be uploaded as well. Malpractice insurance, face sheets, most hospitals go back 5 to 10 years and are going to need those documents. Copy of ECFMG certificates for any foreign medical graduates. There's been somebody in the military, current or past, most medical staff offices would like a copy of the DD 214. Some hospitals require copies of CMEs or at least a list of CMEs, or some just require a CME attestation.

Any kind of documentation like that, if there's any pending, closed, settled malpractice claims, whether the physician was found negligible or not, that information needs to be disclosed. We do ask for government-issued photo ID, a copy of that, because prior to seeing patients, the medical staff office will need to review the photo ID in person. The hospital employee health requirements that may include TB tests, proof of flu vaccine, immunization records, mask testing. Some still require proof of COVID. So it may be necessary for the physician to assist in obtaining that information if they don't have an assistant that has that information on file. And like I said, all the documents that need uploading and requesting, just make sure the application's completed thoroughly and everything's uploaded. Physicians should start gathering a folder, an electronic folder of all these things along the way. Especially the contact information is very important because we're going to need to contact all the verification sources directly to obtain competency, not just from peer references, but the director of residency.

There's a lot of things we get, send a questionnaire to. We use the AMA for verification that they completed that, but we also go further and send information for competency as well.

Johnson: That's great and really helpful. And I want to go back to one of the comments you made just about being upfront about any previous claims or adverse actions against the provider or physician that's applying.

I know that was kind of framed in the medical liability space, but if this is a physician that has been employed or had privileges at another system or hospital facility, and something happened there, is that also something that you're looking for the physicians to be up front about even if it wasn't a legal situation?

Herron: Yes, there's numerous questions on almost every application, whether it's a state mandated app or a facility might use their own application. It's always about current or pending privileges that were voluntarily or involuntarily relinquished or resigned any state license, past actions, there's health questions, and I know there's a, and we might be talking about a little later, but there's a, a movement to get rid of the past mental health questions, but they're still on a lot of the state-mandated apps, and of course, all the claims information, any kind of federal, like a felony or misdemeanor, any of that, has to be disclosed with information, like detailed information about that.

We do have to run a data bank. The NPDB is the National Practitioner Data Bank. Hospitals are required to query the data bank on anyone who's getting privileges, and they're also required to report if the hospital does anything against the provider's privileges.

We also run FSMB, which is the Federation of State Medical Boards to verify all current and past license. So, I mean, there's lots of verifications that are going on, but it's very important for the physician to disclose if there have been any problems with anything that we're asking for.

Johnson: Right. Just be up front from the beginning to get out ahead of it.

Dr Housman: I totally agree with what Beckie's saying, and when we look at an applicant at the hospital level, if there's anything that is a little bit out of the ordinary, whether it's gaps in training, malpractice claims, those sorts of things, having a prepared statement ahead of time will just streamline the process and it can be a very appropriate reason for a gap in training. You may have had time off for maternity leave or had to take time away from training for a medical issue or family issues but addressing that straight away, having a letter from a residency director that explains the time away and, and that you did complete in good standing, that goes a long way to just giving us some peace of mind (and when I say us, I mean the hospital credentials committee), that there's not anything else that we need to further investigate. And similarly, if you've had a significant malpractice event, I always feel like having a letter from your lawyer, from your legal representative that sort of summarizes the event and puts the key information in there will just make it an easier process for you down the road.

Dr Chen: I think that's a great segue to the next question that I have about privileging and exactly what you're, you've been talking about in terms of hospital and facility privileging.

There's a process that all facilities have to go through and it does usually have a lot of physician leader input. Dr Housman, can you tell us a little bit more about this process, either the credentials or privileging committee? You know, why these privileges are needed or how they're delineated and so, and then the process that you all go through within the organization from, kind of, start to finish.

Dr Housman: Sure, we'll describe that for you. So, the primary role of the credentials committee is to look at the privileges that are requested and to, with some degree of certainty, try and assess if the applicant is qualified to do or practice the type of medicine that they're requesting.

In general, you can think of privileges sort of in two buckets. They're privileges that we call core privileges, or considered to be a core privilege of anyone that's completed a certain type of residency program. So in my personal background, I'm an OBGYN. And so, by virtue of going and completing an OBGYN residency, there's certain expectations that I'll be able to deliver a baby and do a C-section and address women's health, both in primary care and then also surgically.

So we look at the applicant to see if they've got sufficient criteria to be deemed acceptable to perform those things. And then we also look at privileges that we consider outside of those core privileges that might be a special privilege. And probably the easiest example in the OBGYN world of special privileges, we consider any use of robotics to augment your surgeries as a special privilege.

So not every training program has robotic capabilities, and so if you're going to request robotic privileges at our facility, we either need separate documentation that shows that yes, I've had prior experience in training in my residency program, or that I've gone through the appropriate training and I have a sufficient case log to justify requesting that privilege.

So, the advice that I would give an applicant with regards to privileging is to be very diligent with the case logs. That process is a little bit easier for a recent residency or fellowship graduate. Oftentimes, they can get a letter from their program director that'll summarize their proficiency and that will be sufficient.

If you're moving mid-career or going to be new to a market, that's where having a detailed and accurate case log, especially if you're a proceduralist, somebody, a surgeon or someone that has certain procedures that they do, the more information, the better. So that we as a committee, when we look at it, again, if we're considering an obstetrician, we can see very clearly, yes, they've managed many, many patients in labor, they've done many vaginal deliveries. They've done the cesarean sections. They're also skilled at laparoscopy and performing hysterectomies. And we can have a good comfort level in allowing that provider to perform all those functions within our facility.

Dr Chen: Thank you for outlining that in such detail. I think that's very helpful for our listeners to sort of understand, you know, peel back that onion and understand what exactly is happening. Are there any other sort of points or issues that you look for besides, sort of, experience and training in, in terms of privileging or granting privileges to a physician?

Dr Housman: Well, a little bit, and we've alluded to it in a couple of different instances, especially for somebody that has been out of training for a little bit, or maybe is mid-career, the malpractice history is going to be important to us.

If a person has had a significant number of claims from a Credentials Committee standpoint, it may prompt us to ask a few more questions on certain circumstances. We've even called and interviewed a candidate to try and ascertain some more details around those malpractice circumstances. Obviously, if it's been a significant event, the National Practitioner Data Bank is going to have an entry in there as well. So, that might prompt more discussion.

Unfortunately, we don't oftentimes have access to things like peer review that may have come from another facility or those sorts of things. So, it can be a little bit tricky if you're trying to determine the capability or the quality of a physician applicant, particularly somebody that's been out of training for some time.

But that's the job that's put in front of the Credentials Committee, is to try and establish a minimum level of safety that the public can feel reassured that if they're coming to your facility to have this procedure done or to receive health care, that their provider is adequately trained and safe to provide that, that level of care.

Dr Chen: Gotcha. And let's say a physician is denied privileges and wants to understand more fully why, or really would like privileges at the hospital, is there an appeals process, for instance, at your institution, or how is that handled?

Dr Housman: Again, that can be a little bit of a tricky situation. Denying privileges can be a reportable event to the National Practitioner Data Bank. So that's a situation we really try to avoid. If there are questions about an applicant, there's a lot of work that goes into trying to really ascertain what's going on with this applicant.

Are there extenuating circumstances that need to be considered? So it's a pretty rare occurrence. To just out-and-out deny privileges. And so the, the more thorough you can be the more complete you can be, the more open and honest you can be, it's just going to make that process that much easier.

Dr Chen: Right. I think it's, it's heartening to know that it's, it's more of a dialogue almost before that final determination to gather more information, etc, from the committee's standpoint. And it's not necessarily anything more than that. It's especially if you're called and asked to come in.

Dr Housman: Yes. I can't obviously speak for all hospitals, but at least within our system, I think it would be a pretty rare circumstance that you would be shocked at the outcome of your application for privileges. There would be several phone calls before you got a phone call that just said, “Oh, the committee met last night and they didn't like your file, and too bad, so sad.” That that's not really the way we approach it.

As you said, it's much more of a dialogue and let's, let's understand each other and understand what we're discussing here.

Dr Chen: Right, and I think I'd be remiss not to mention this, and I think Beckie touched on this, there's a movement, and the AMA is fully supportive of these movements to remove historic mental health questions from applications, especially to state medical boards, etc. And I know there's also a movement within hospitals and health systems to do the same. What has your system, sort of, adopted at this point in that situation? Those historic, maybe not current, obviously current mental and behavioral health issues are pertinent to the discussion of whether or not a physician is competent to practice and have privileges, but those historic ones that may have already been treated or may have been a long time ago that are resolved, those questions may be stigmatizing. So what does your organization, what have you adopted for your processes?

Dr Housman: Well, and I may have Beckie comment on this too. Unfortunately for the state of Kentucky, it is on some of our state forms. And so we have tried to confine our questions to what's in that state form. We do have to use that form. We do have to address those questions. So we try and be sensitive to that. We are, I feel like very fortunate in the state of Kentucky, we have a very robust physician support network in the Kentucky Physicians Health Foundation. So if there are questions of impairment or capability of practicing the KPHF, the Kentucky Physicians Health Foundation, is a wonderful partner for us and somebody that we can appeal to help give us some further understanding or oversight on a physician that, you know, may have some current issues that they're working through.

We've had a number of physicians across our system that have participated in the KPHF. Oftentimes, it can be a bit of an arduous journey, but again, it's a wonderful support tool that we have for keeping physicians in the workforce, helping them get help with whatever impairment it may be, whether it's mental health, physical impairments, substance abuse. We certainly are fortunate here in the state of Kentucky to have that resource. So, Beckie, I don't know if you have any other thoughts on that question.

Herron: Yes, the KAPER, which is the Kentucky state-mandated application, has not been edited yet. There is a movement, one of the physicians in our Baptist Health Network is trying to get those questions changed.

So I think one thing just to remember is the primary goal of an acute care hospital or a surgery center or any health care is providing quality care and the medical staff services in the CVO, we try to align with this goal to follow established processes to ensure that only appropriately educated, trained, qualified, and competent physicians provide patient care services.

Johnson: Those were all great points. I want to switch gears a little bit here to that last step in this process. And so we've heard that getting physicians enrolled with payers may be the most complicated part of this process. Beckie, can you walk us through this step and just kind of highlight if there are any differences between the enrollment for government versus commercial insurance payers.

Herron: Yes, it depends. Every insurance payer is going to have their own process and their own requirements. Medicare is the one that they usually defer the most to. Like we were talking about, everybody has to have an NPI. Everybody has to have the EIN, which is the Employer Identification Number, or a tax ID, which is the taxpayer identification number.

Physicians have to supply one of these to enroll in Medicare. And Medicare also goes further that they have a PECOS system where it's a database of all their providers to be registered with CMS. And even more data that they have to input is CAQH. And it is voluntary to participate in CAQH, but most health care networks, and, use the CAQH portal. Now, Medicare uses PECOS, but your Anthem, Blue Cross Blue Shield, you know, your Aetna, Humana, UnitedHealthcare, they're all going to use the CAQH portal. And that information is meant to be input and kept up. They also, Medicare, Medicaid, TRICARE, there's PTAN, they have to have a provider transaction access number. There's all these numbers that they have to apply for and obtain in order for the provider enrollment process to even start. And I think because they differ in what they request, like I was saying, Kentucky Medicaid, requires a social security card. That's just one little example because they request so many different things and some of them are the same that we get on the hospital end. Enrollment can take between 90 and 180 days, which is 6 months.

Hopefully it's, you know, 60 days or under is our goal for the hospitals. But you start seeing patients, the good thing with provider enrollment is a lot will backdate. So that's an important thing to remember with hospital privileges. You're, there's no backdating. The day the board approves them is the day the board approves them. But a lot of times they're at the mercy of when the payers want to approve it, when Medicare wants to approve it.

Johnson: Beckie, I know you mentioned the timeframe, and I want to touch on that specifically because I think it's kind of a hurry-up-and-wait situation. So, you mentioned it could take up to 180 days for a physician to be credentialed with a payer. As these approvals are coming in, is that something that your department is in contact with, with the physicians or with the scheduling team for what patients they can start seeing? Or how does that work?

Herron: So they, they, yes, the medical staff office works closely, you know, with the usually the practice manager is the one that is trying to get them on the schedule.

So they work closely together, you know, if it's employee person with our onboarding team, because they have usually a goal start date and that start date is when they can see patients. So yes, everybody tries to work together to get the physician to see patients by their start date. And if it's a physician that is working in an office, sometimes they'll have them, you know, round on patients in the office setting instead of rounding in the hospital. If there's a holdup with the file, like there's a peer that hasn't responded, so it can't be approved yet. Or sometimes files are only waiting on like one thing to finish and, you know, the physicians can help with that or their admin, their credentialing, their onboarding coordinator, any of the people can try to help get those documents into the CVO so that it can go to the medical staff office. But I think to accomplish all that we have discussed correctly and thoroughly, the credentialing process takes time and that amount of time it varies by the organization's policies, it varies by the length of time the physician's been in practice.

A physician, brand new out of residency, the time is going to be a lot less. It should be a lot less because you just left residency. So that's the biggest wisdom is, it takes time, it is a huge process, especially on the provider enrollment end.

Johnson: Great. Yeah. It sounds like you guys have a great process at your organization and just a lot of communication throughout is key, is something that I keep hearing, which is really refreshing to know that everyone works together to get this done.

Dr Chen: Beckie, real quick question for you. You mentioned CAQH. Can you define that acronym for some of our listeners who may not be familiar? And tell us a little bit more about what that is.

Herron: It's a coalition they started and it, it's a provider data portal. It was meant to replace all of everyone else's paperwork across anywhere. It's supposed to be updated constantly. And that was the big appeal of it, going to be the big appeal of it is everybody could use it.

But basically, it's just for non-Medicare for providers to put in all their data to the CAQH provider data portal. And it is voluntary, however, if you want some of the payer information, some of the payer approval, you're going to have to use it. Your employer, if you join a group, if you're a physician joining a group, they'll want your CAQH login information so they can help keep it up.

And if you're an independent provider, it's a little bit harder. If you don't have the, like I kept saying credentialing assistant, we call them credentialing admins. I think that's the best for employee physicians. They should have a dedicated credentialing admin to help them through all this. They can data-enter stuff. So if you're a physician joining a group, maybe ask, do you have somebody that's like a dedicated credentialing admin that helps with this information?

I think for physicians that move from state to state, like in a locums position, that's going to be more important than anything because that's a lot of data entry, a lot, all the time.

Dr Chen: Yep, if physicians have help to do this, it's a, it makes the process all the less painful.

So, Dr. Housman, from your experience, what are some tips both from the applicant and organization perspective, that can make the credentialing process run smoothly? What are the biggest pitfalls too?

Dr Housman: So, I think overall, and really the answer is almost the same for the applicant and for the facility, is being, being thoughtful, being organized, and being thorough.

So, from the applicant's perspective, we've talked a little bit about some of the requirements, some of the documents that you need, particularly paying attention to if you have something that's atypical, like a gap in coverage or malpractice history that needs to be addressed. I can't stress enough, having very detailed case logs is extremely helpful to the credentialing committee when they start to look at privileges and try and establish what privileges should be given to a provider, especially for someone that's a surgeon, or that may have procedures that they need to perform. Then on the hospital side, certainly trying to be as efficient as possible, being organized with files.

Dr Chen: Well, thank you so much for being on this conversation with us today, Dr Housman, and providing your insights as well. Really appreciate it.

Housman: Absolutely. Thank you again. It's been fun.

Dr Chen: And, you know, I asked Dr Housman what tips and tricks are for applicants and organizations that can make things run smoothly. And I think you've already touched upon a lot of these things, but I think one of the main things we can learn is what are the pitfalls that you see frequently in that process for physicians, and are there tips and tricks to avoid those pitfalls?

Herron: A lot of times it'll be, oh, we've got to hurry. This provider needs to start in 2 months, say, and that 2 months does seem like a long time, but to have to accomplish all this, it's really not. So, as soon as you can get started on credentialing, the better. Get started as soon as possible. Don't let it sit there, and we're really good about letting people know, giving updates, say, “Well, we've got, you know, 2 of your references in, but Dr Smith hasn't come in yet. And we've tried to call him. Is there any way you can call him?” Because maybe he's changed email addresses or maybe he has a different phone number now.

So it's just anything they can do to help out. And just remember, we have to, they have to go to reappointment every 2 to 3 years as well. But that's another topic for another day.

Dr Chen: Thank you, Beckie, so much for being here today. It's been a pleasure hearing from you and having all your input on these sometimes-complicated, but ultimately necessary steps into being able to practice medicine.

Herron: Thank you so much for having me. I really appreciate it.

Dr Chen: Dr Brad Housman, Vice President and Chief Medical Officer at Baptist Health in Kentucky, and Beckie Herron, the Director of Credentials Verification, also at Baptist Health, have been our guests today.

Baptist Health is a full-spectrum community-based health system serving Kentucky and Southern Indiana, consisting of 9 hospitals, employed and independent physicians, and more than 400 outpatient points of care. The Baptist Health Medical Group is an AMA Health System member. Check out the episode description to explore the resources mentioned in today's episode. And until next time, stay well.

Speaker: Thank you for listening to this episode from the AMA's STEPS Forward podcast series. AMA's STEPS Forward program is open access and free to all at STEPSForward.org. STEPS Forward can help put the joy back into medicine by offering real-world solutions to the challenges that your practice is confronting today. We look forward to you joining us next time on the AMA's STEPS Forward podcast series. STEPSForward.org.