Privileging

The hospital-specific process of authorizing a credentialed provider to perform specific clinical services and procedures within that facility.

Privileging is the step that comes after credentialing at a hospital or facility. Credentialing verifies that you are who you say you are and that your qualifications are legitimate. Privileging determines exactly what you are allowed to do at that specific facility. Privileges are delineated by specific procedures and services. A general surgeon might request privileges for appendectomy, cholecystectomy, hernia repair, and bowel resection. An internist might request privileges for medical admissions, critical care consultation, and central line placement. Each requested privilege is evaluated based on your training, experience, current competence, and the facility's capability to support that procedure. The privileging decision is made by the medical staff office and the department chair, with final approval by the hospital's governing board. They review your case logs, training records, and references to determine whether you have demonstrated competence in each requested procedure. New privileges are typically granted on a provisional basis for the first one to two years. During this provisional period, your cases may be reviewed more closely. You might be required to have a proctor observe a certain number of procedures before you can perform them independently. For payer credentialing, your hospital privileges matter because payers ask about them on enrollment applications. They want to know which hospitals have granted you privileges, what specific privileges you hold, and whether any privileges have ever been denied, restricted, or voluntarily relinquished. If you practice exclusively in outpatient settings and do not have hospital privileges, most payers will accept that. But you may need to explain your admitting arrangements. Some payers want to know that if one of your patients needs emergency hospitalization, there is a plan in place for who provides the inpatient care. Keep a record of your privilege delineation at every facility. When you apply for credentialing with a new payer or hospital, having your current privilege list readily available speeds up the application process.