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View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
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Learn MoreHealthStream regularly publishes guest blog posts like the one below from Angela Beardsley, CMPSM, CPCS, Consultant and Jackie Jones, CPMSM, Senior Consultant.
For Medical Services Professionals (MSPs) who are new to the profession or even seasoned MSPs who are not regularly involved in privileging processes and are interested in a brief refresher, the following are some privilege basics.
Credentialing is "the process of assessing and confirming the license or certification, education, training, and other qualifications or a licensed or certified healthcare practitioner."
Privileging is "the process of authorizing a healthcare practitioner’s specific scope and content of patient care services."
"The Centers for Medicare & Medicaid Services (CMS), is part of the Department of Health and Human Services (HHS)." The "CMS develops Conditions of Participation (CoPs) and Conditions for Coverage (CfCs) that health care organizations must meet in order to begin and continue participating in the Medicare and Medicaid programs. These health and safety standards are the foundation for improving quality and protecting the health and safety of beneficiaries." The CMS CoPs related to Privileging are:
§ 482.12 Condition of participation: Governing body
(a) Standard: Medical staff. The governing body must:
(6) Ensure the criteria for selection are individual character, competence, training, experience, and judgment; and
(7) Ensure that under no circumstances is the accordance of staff membership or professional privileges in the hospital dependent solely upon certification, fellowship, or membership in a specialty body or society.
§ 482.22 Condition of participation: Medical staff
(c) Standard: Medical staff bylaws. The medical staff must adopt and enforce bylaws to carry out its responsibilities. The bylaws must:
(6) Include criteria for determining the privileges to be granted to individual practitioners and a procedure for applying the criteria to individuals requesting privileges.
Additionally, the CMS requirements for hospital medical staff privileging are outlined in the CMS letter dated November 12, 2004, which requires the hospital’s governing body to ensure "that all practitioners who provide a medical level of care and/or conduct surgical procedures in the hospital are individually evaluated by its medical staff and that those practitioners possess current qualifications and demonstrated competencies for the privileges granted." The letter further states:
The "CMS also ensures that the standards of accrediting organizations recognized by CMS (through a process called "deeming") meet or exceed the Medicare standards set forth in the CoPs/CfCs." Health Care Organizations seeking CMS approval may choose to be surveyed either by an accrediting body, such as The Joint Commission (TJC), Healthcare Facilities Accreditation Program (HFAP), and DNV-GL; or by state surveyors on behalf of CMS. Types of healthcare organizations to which the CMS standards apply and also at which Privileging is typically applicable are hospitals (including acute care, critical access and psychiatric), surgery centers, mental or behavioral health centers, and Federally Qualified Health Centers (FQHCs). This is not to say however, that there are not other healthcare organization types that perform privileging, these are just the most common, and also the ones that typically have other Accreditation Standards (TJC, HFAP, DNV-GL, AAAHC, HRSA) related to privileging that they must meet as well, in addition the CMS’s CoPs related to privileging.
Ready to be a privileging superstar? See how CredentialStream's® Privilege solution can help you fortify patient care, satisfy providers, and comply with industry regulations.
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View All Learning & PerformanceHealthStream offers performance learning management solutions to help develop your healthcare staff into leaders and reduce turnover.
View All ProductsHealthStream works with healthcare organizations to create engaging and high-quality training videos for your staff and management.
View All ProductsImprove care quality and save money by making informed decisions about your healthcare facility and staff with HealthStream's reporting analytics solution.
View All ProductsHealthStream's proven methods for the improvement and overall engagement of your healthcare staff foster a positive workplace and increase retention rates.
View All ProductsWhen you enact HealthStream's quality compliance solutions, you can do so with the confidence your healthcare organization will meet all standards of care.
View All Quality & ComplianceBe confident in your staff’s ability to reduce risk by providing compliance training that changes behavior.
View All ProductsDevelop next-level people for next-level care by prioritizing quality and safety improvements.
View All ProductsEstablish a culture of belonging with education supporting DEI, wellness, engagement, and leadership development.
View All ProductsUtilize patient access solutions and advanced reimbursement solutions to manage clinical denials and improve your organization’s reimbursement strategy.
View All ReimbursementExpand the decision-making skills and effectiveness of your healthcare workforce with HealthStream's clinical development programs and services.
View All Clinical DevelopmentLearn about our advanced resuscitation training solutions. Our solutions are designed to help improve patient outcomes.
View All ProductsOur competency development solutions personalize learning for clinicians to bridge the gap between theory and practice for your nurse residents.
View All ProductsEnhance maternal & child nursing care with solutions focused on improving the quality of care for mothers, infants, and children.
View All ProductsAddress staffing orientation challenges to easily achieve and maintain certification with our emergency and acute care training solutions.
View All ProductsAs a premier provider of healthcare education, we are committed to promoting safer, more successful surgical and sedation outcomes for each and every patient.
View All ProductsOur solutions are designed to cater to the needs of patients, healthcare professionals, and organizations dealing with illnesses or chronic conditions.
View All ProductsOnline clinical placement software allows schools, healthcare organizations, and students to seamlessly manage clinical and nursing rotations.
View All ProductsComprehensive, industry-leading provider onboarding and credentialing software that validates health outcomes and supports provider assessment.
View All CredentialingOur affordable CVO credentialing services establish patient safety by enabling primary source verification for your healthcare organization.
View All ProductsIntegrate with Epic to validate and add new providers directly to your provider master file.
View All ProductsMake sure your healthcare staff can schedule out appointments and work schedules with ease using HealthStream's line of software solutions.
View All SchedulingHealthcare workforce management is essential. We provide advanced scheduling solutions for organizations to solve issues such as nurse retention
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