Career & Finances | Legal / Ethical | Licensing | Licensing Info | Original Content

Medical Credentialing: What is It and Why Does It Matter?

  • Have you ever looked at a professional’s medical credentials and wondered, “What do all of those letters stand for?” I know that I have.
  • Providers put their blood, sweat, and tears into obtaining their medical credentialing and they are not the only ones who benefit from it. 
  • To learn more, check out Nursing CE Central!
Morgan Curry, RN/BSN

Morgan Curry, BSN / RN

Intensive Care, Outpatient Surgery, Aesthetics, Education, and Nursing Leadership

August 13, 2021
Simmons University

At some point in your career, I am sure you have seen all kinds of letters behind a colleague, boss, or mentor’s name and wondered what it all stands for.  

 It looks like a different language.  

But did you know that those letters are credentials have costed healthcare professionals thousands of dollars and countless hours of their life?  

From studying for exams to clinical rotations, so much time and effort has been put into those few letters that precede their names. 

So, if it isn’t just for the title, why is medical credentialing so important? 

What Is It?

Value-driven healthcare solutions provider, Advantum Health, defines medical credentialing as “a meticulous review process of a health provider’s qualifications.” 

Potential employers will evaluate factors within a provider’s medical credentialing including government-issued identification cards, background checks, education or training certificates received, board certifications, and professional licensing. 

This review process can be time-consuming and unrealistic for busy management teams to look over, so oftentimes, a third-party medical credentialing review organization will be contracted to overlook this step in a new provider’s hiring process.  

Additionally, most provider’s medical credentials are available to the public online, granting patients the opportunity to review and determine who they want to visit to meet their healthcare needs.  

Although one might assume that medical credentialing is only applicable to physicians, that is far from the case; RNs and APRNs both must endure the legitimacy, medical background checking process, too.  

Why Does It Matter?

It is evident that we reach an increasingly vulnerable state when visiting a healthcare professional, as we must discuss topics regarding our own health and wellness habits, which, to some, can be quite uncomfortable.  

As a nurse, mother, and patient myself, we want to fully trust our nurses and physicians who are caring and advocating for us and our families, right? 

Although the task itself may be tedious, medical credentialing is essential for the patient, provider, and healthcare facility. Medical billing experts, NGC Medical, highlights some of the top pros of medical credentialing, check them out: 

For the patient:  
  • Allows them to see the expertise of a prospective provider, or if they have been previously disciplined by their board of medical licensure 
  • Builds trust between them and the selected provider 
  • Improves their safety while in the facility 
For the provider:  
  • Increases patient base 
  • Establishes credibility 
  • Ensures professionalism and reputation 
  • Delivers competitive edge 
For the facility: 
  • Decreases medical errors 
  • Enhances hiring processes 
  • Prevents losing revenue 
  • Ensures quality assurance 

By assessing and confirming the qualifications and credentials of your providers, it allows institutions to be able to employ the most qualified and experienced professionals in their field and save them from a number of liabilities including poor or unsafe healthcare, risk of compliance violations potential lawsuits.  

Additionally, it builds rapport and trust between providers and patients during their most vulnerable times.  

So, the next time you see a provider with so many credentials following their name that you cannot even begin to process what it all means, take a second to research what it stands for and then appreciate the endless amount of time and effort that they have put in to earn that title.  

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about the author

Morgan serves as the Course Curriculum Executive Editor and Content Manager at NursingCECentral.com. Her extensive background in a Level I Trauma Hospital setting provides vast clinical insight into high octane clinical care, along with a deep understanding of specialized areas of nursing such as heart and lung transplants, ECMO, and cardiac surgery recovery.

Morgan’s professional versatility also extends into the highly sought-after field of aesthetic nursing, with comprehensive experience in the Plastic Surgery field; including nurse leadership in PACU, PERI-OP, and OR departments.

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