Credentialing and Privileging
Verification is primary-source
Credentialing establishes who the practitioner is; privileging establishes what the practitioner may do. The exam tests the pipeline: complete application, primary source verification (PSV), queries, committee review, MEC recommendation, governing body appointment, and privileging. PSV means verification from the original issuing source or an approved equivalent: state licensing board, ABMS or specialty board, DEA, NPDB, OIG LEIE, and SAM. Query the NPDB at initial appointment and reappointment. Screen for exclusions at hire and, as best practice, monthly.
Privileging decisions
Privileges are granted for the specific procedures and scope the organization can support. Core privileges cover a defined scope; special privileges require additional criteria, often volume, board certification, or proctoring. New privileges trigger a focused professional practice evaluation (FPPE). Reappointment cycles vary: state law commonly caps them at 24 months, while The Joint Commission permits reappraisal at least every 36 months. Apply the stricter rule and document which one governs.
Worked example
An applicant's license lapsed four months ago and was reinstated. Reasoning: verify the current license by PSV; query the NPDB; obtain a written explanation and any board order; evaluate whether the lapse reflects a competence or conduct issue; document the committee's rationale. A lapse is not an automatic denial, but ignoring it is a credentialing failure.
Traps that cost marks
Accepting a photocopy or a hospital file as PSV; missing an expired DEA; privileging beyond state scope; skipping the NPDB query at reappointment; granting temporary privileges without a written policy and time limit; and recording a decision without the rationale that supports it.