Medical Credentialing

Medical credentialing ensures the effectiveness and quality of medical care. Credentialing is used to evaluate a healthcare provider’s qualifications and practice history. The credentialing process may include the review of a healthcare provider’s education, training, residency, licenses, and certifications. Through credentialing, group practices and hospitals can determine a healthcare provider’s suitability for joining their staff. Health maintenance organizations (HMOs), preferred provider organizations (PPOs), and other similar provider networks also credential healthcare providers

Medical credentialing issues can have serious consequences for healthcare providers and their businesses, such as the termination of staff privileges and reports to state and national databanks. If you’re facing medical credentialing issues, it’s important to retain experienced legal counsel and settle matters in a way that results in minimal collateral effects. 

 

Representing Medical Staff in Credentialing Cases 

The attorneys at Jones Law Group in Columbus, Ohio counsel and represent healthcare providers, hospitals, and other organizations regarding medical staff privileging and credentialing matters. We have worked with all types of healthcare providers, including nurses, physicians, dentists, and chiropractors, among others. 

Using our expertise and knowledge, we inform individuals and organizations regarding their rights and obligations under state and federal law. Our aim is always to take a non-adversarial approach and avoid disputes, but when conflicts arise, you can count on us to advocate for you in court, at peer review hearings, and before arbitration panels. 

 

Staff Privileges 

Hospital affiliations and privileges are central to many physicians’ practices. Without these privileges, it can be difficult to get patients or referrals. If a physician loses his or her hospital privileges or has them limited in any way, it could be reported to the National Practitioner Data Bank (NPDB). This would make it more difficult to obtain credentialing at a hospital or find employment in the future.

 

Peer Review Process

Hospitals, surgery centers, and other healthcare facilities are under significant pressure to evaluate the credentials of healthcare professionals and effectively conduct the staff privilege and peer review process. The peer review process involves having physicians evaluate the qualifications and quality-of-care of colleagues. Establishing a peer review committee is a requirement for hospitals that participate in the Medicaid and Medicare programs. 

The peer review process, when conducted properly, protects patients from substandard care, combats medical errors, and prevents injury and death. Sometimes, however, the peer review process is used for unjust purposes, such as retaliating against a physician to get rid of competition. An unfair peer review process can have devastating effects on your career. If you are subject to an unfair peer review process that is unrelated to your performance as a healthcare provider, it’s essential to act quickly. 

 

Consult the Healthcare Attorneys at Jones Law Group

Based in Columbus, Ohio, Jones Law Group has extensive experience representing physicians who are at risk of losing their hospital privileges. Our attorneys will listen to you and aid you in developing a plan that accomplishes your goals. We will provide you with practical legal advice and solutions to help ensure that you’re able to continue practicing medicine. Call (614) 545-9998 or contact us online to set up a free initial consultation with our medical credentialing attorneys. 

 


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