Now you represent the insurance company. Read through the posts that your fellow students submitted as their first post. Find a post that interests you, then respond to it. Remember, you are now repre

Now you represent the insurance company. Read through the posts that your fellow students submitted as their first post. Find a post that interests you, then respond to it. Remember, you are now representing the insurance company. Your goal is to question the hospital’s ability to find competent doctors. Are they covering their bases? Should the hospital be considering other factors when granting privileges to doctors? If this hospital does grant privileges to incompetent doctors, your job is on the line. Why? Because you provided the hospital with a policy, and it will have to pay on a malpractice suit if one of their doctors is negligent. So be thorough!
Peer post:
My duty as a hospital administrator and taking part with the credential committee, observing and overseeing various features with granting privileges when selecting physicians nearby and making them a part of our team here at the hospital is a process. Establishing great quality care for our patients is top priority, therefore, keeping within medical staff’s permissions restricted per bylaws and requirements of the organization is a well-thought-out plan that has been set in place helping thoroughly with the hiring process. Understanding that there is more to bringing on good qualified physicians, goes deeper than just reviewing through their credentials. “Medical staff privileges are restricted to those professionals who fulfill the requirements as described in an organization’s medical staff bylaws” … “Appointment to the medical staff and medical staff privileges should be granted only after there has been a thorough investigation of the applicant. The delineation of clinical privileges should be discipline-specific and based on appropriate predetermined criteria that adhere to national standards” (Pozgar, 2019, p. 221). Assuring the insurance company is important, this hospital takes matters seriously, we abide by rules and regulations, follow protocol and function effectively and efficiently without fail. Being responsible begins the start of the process before even considering recommending any potential applicant physician to the governing body. Reviewing each step carefully, will take a process when defining medical privileges, a method used towards evaluating how one has participated, performed, has improved throughout, and past peer reviews as well. Below you will find a submitted outline, it has been provided for your information as needed, giving a clearer picture of how the hospital conducts its hiring process is very important, hopefully this will satisfy what you are looking for. The aptitudes we take in finding competent physicians are goals set by this hospital, we will not be content if we deviate from the hospital administrative standards set in place.
“Application
Medical Staff Bylaws
Physical and Mental Status
Consent for Release of Information
Certificate of Insurance
State Licensure
National Practitioner Data Bank
Interview Process
Delineation of Clinical Privileges
Governing Body Responsibility
Appeal Process
Reappointments” (Pozgar, 2019, p. 221-224).
The application includes data regarding the potential physician’s education such as, medical school, internship and residency programs, active and up to date license(s) in order to practice medicine, are they board certified and do they carry medical malpractice coverage?
Being board certified gives a platform to authenticating the applicants’ expertise and vital skills. This requirement will bring forth optimum promising medical care to our patients, especially with certain medical specialty.
All employees are adhered to signing a medical staff privileges, confirming statement of that with the bylaws, having read and understood, agreeing to following standards of operations, agreeing to release information from any third party, and any other matter approved by this hospital and the bylaw procedures.
It is mandatory for all applicants to undergo a physical and mental evaluation, very important matter prior to being selected and assigned medical staff privileges and duties. Providing proof of medical malpractice insurance, and medical license to be able to work within the state, as well as passing the National Practitioner Data Bank (NPDB), this will assess credentials provided and the hospital will continue further checking the references systematically.
“Doctors must apply for privileges to admit and treat patients at hospitals. If you have a preferred hospital, it is important that the doctor has privileges to practice there. Some sites will note which hospitals a doctor is affiliated with. These facilities do additional and ongoing checks of the doctor’s credentials, which can be an assurance of their validity.” (Torrey, 2019).
Pozgar, G., D. (2019).
Legal Aspects of Health Care Administration
(13th ed.). Burlington, MA: Jones & Bartlett Learning.
Torrey, T. (2019, July 7).
How to Check a Doctor’s Background and Credentials.
Retrieved from
https://www.verywellhealth.com/how-to-research-a-doctors-credentials-2614997







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