Medical Credentialing – From the Medicine Man to Telemedicine

Apr 14, 2021 | Credentialing, Fraud / Waste / Abuse, Hugh's Credentialing Digest, Provider Management, Telehealth

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A Brief History of the Evolution of Medical Credentialing

In this blog, Hugh Greeley offers a brief summary of medical credentialing throughout history spanning from 1800 BC to the late 1990s to today. Credentialing evolved from early practitioners who relied primarily on reputation, word of mouth, and personal attestation; to the use of documents such as diplomas, letters of recommendation, and certificates; to the later use of electronic documentation of important aspects of a healthcare practitioner’s credentials. With the advancement of technology, the mantra, “Do it once, do it well, securely store it, and provide verified current data to all in need,” is achievable today.

Why is Medical Credentialing Important?

Patients are entitled to care from a physician who is properly educated, trained in specialties, and someone who does not carry a record of adverse behaviors that could put a patient in danger. Health systems adhere to quality standards that represent their agreement to comply with important actions that result in quality care and good outcomes. Payer organizations that reimburse for medical services have strict rules of compliance to standards in order to submit for reimbursement. State and Federal entitlement programs, as well as private health insurance companies, do not want to reimburse for services given to a patient by someone who has an impaired license because of illegal or unethical behavior.

The Role Data Plays in Medical Credentialing

As mentioned later in this blog, the implementation of aggregated digital databases such as the Fraud Abuse Control Information System (FACIS®), the National Practitioner Data Bank (NPDB), the American Medical Association Physician Masterfile, and the Office of Inspector General’s List of Excluded Individuals and Entities (OIG LEIE) serve as tools to verify physicians’ credentials and expose exclusion and other adverse actions related to healthcare practitioners. With today’s technology, in particular, Verisys’ CheckMedic® MedPass® verifies, stores, and locks static data throughout a practitioner’s career, such as full name (and when changed through marriage, etc.), date of birth, social security number, as well as primary source verified professional information, including education, training, licenses, certifications, and registrations. This matched and verified data is securely preserved and made available digitally to all individuals and entities requiring primary source data for screening, verification, and credentialing providers.

In the following blog post by Hugh Greeley, a description of the evolution of credentialing through the ages examines how data and technology have come into play.

Early Practitioners – Verbal Confirmation of Credentialing

  • BC-1800 — Practitioners of the healing arts are largely self-anointed and respected by the population. These include shamans, barbers, medicine men, etc.
  • 1800-1850—Personal attestation to completion of medical school is the criterion for medical practice.

Post-Industrial Revolution – Beginnings of Hardcopy Documentation

  • 1850-1900—Visualization of licensure and a diploma from a medical school plus, perhaps, a letter of introduction from a respected professor or dean are required for medical practice (the letter or certificate of appointment might be maintained in a file).
  • 1900-1935—A written application completed by the physician and maintained by the hospital in a permanent file is the practice (there is very little documented verification in the files).
  • 1935-1960/70—Original or official duplicates of a license, diploma, residency completion certificate, letters of reference, board certification certificates, plus the all-important recommendation from an existing staff member are required (a minimum file is maintained).
  • 1960-1970—Copies of a license, letters from medical school, residency, board, malpractice carrier, litigation history, references, and recommendations of existing staff members are collected (increasingly large paper files are maintained).
  • 1970-1995—All of the above are required, plus AMA Masterfile Profile, work/hospital affiliation history, continuing medical education (CME) record, and disciplinary action history, where available. Obtaining a recommendation from an existing staff member fades in importance (paper files are maintained).
  • 1992—The Fraud Abuse Control Information System, FACIS® is created ahead of the electronic curve. Starting with paper files from dozens of primary sources such as licensing boards and the Office of Inspector General and then digitizing the data for the purpose of aggregating and organizing for the ability to search the data, to using the latest data science to collect, verify, aggregate, and match the historical and current data to individuals and entities. FACIS® is the gold standard of healthcare provider data for exclusions, debarments, sanctions, and disciplinary actions.

Modern Technology – Electronic Documentation

  • 1995-2010—All of the above are in use for credentialing, plus a National Practitioner Data Bank (NPDB) report, cumulative sanctions search, and criminal background check (paper files begin to be replaced by electronic files).
  • 2010 and on—Additional documentation and verification are required (paper files phase-out, electronic files are maintained by the hospital in software programs or in the cloud on data-driven SaaS platforms).

Note that the photocopier, which began being used in many offices during the 1960s, changed what was maintained in the file and how the later advent of the Internet changed everything.

Did the Shaman need Credentials? 

In summary, compared to the early years, where anyone who decided to claim healing skills was able to practice medicine, and with the absence of professional criteria, the population served as training subjects for early healers. Now, with high standards for qualification through education, training, and regular unimpaired practice verified and documented electronically in the cloud, the credentialing mantra of, “Do it once, do it well, securely store it, and provide verified current data to all in need” is a reality. The medical industry has arrived at this objective of real-time credentials verification thanks to cloud-based SaaS access to primary sourced data platforms.

Verisys was founded on the premise of providing a single source of truth with FACIS®, the Fraud Abuse Control Information System, which is a database of more than 10 million records aggregated and dating from 1992 to current, real-time data on individual and entity exclusions, debarments, sanctions, disciplinary actions, and other adverse behavior.

Verisys’ SaaS credentialing platform, CheckMedic® automates the medical credentialing process with its access to thousands of primary sources and uses sophisticated algorithms to match records to identities with 99.9% accuracy. A MedPass® is issued for each individual and entity allowing secure, cloud access to digital credentialing profiles.

Hugh Greeley Written by Hugh Greeley
Credentialing and Healthcare Industry Expert
HG Healthcare Consultant