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Semantics. Explaining the Credentialing, Privileging process for L.Ac.s as Licensed Independent Providers (LIPs)
Explaining Credentialing, Privileging, and
Independently Practicing Provider
by Megan Kingsley
Gale, EAMP, Dipl. O.M. (NCCAOM®) Thank you to contributing subject matter advice by colleague Fuji McPherson, ARNP, DOM, Dipl. O.M. (NCCAOM®)
updated BLS code reference 2016.08.29
and the hospital process.This paper is
to help inform a process that is new to our AOM community in general. We hope this helps others learn the lingo and
These are terms not commonly used in private
practice.They are, however, terms used
in hospital and medical center practice settings that make the difference
between practicing as an independent provider (no direct medical supervision)
and practicing as a technician.
What is a privileged
health care practitioner?
The following is a general checklist for qualifications of a licensed medical provider who is being considered as a hospital hire and going through the process of credentialing and being granted a delineation of clinical privileges:
Licensed health care practitioner
State scope of practice allows for independent practice (e.g. acupuncturist, physical therapist, chiropractor, licensed clinical social worker)
Performs specific therapy regulated by medical board or health professions board
Holds a current, unrestricted license to practice in his/her field
Has a degree from an accredited education institution, recognized by the U.S. Department of Education
Successfully passed national board certification in the field of study
Participates in continuing education and peer record review processes
Consults with other licensed medical professionals
Supervised Health Care Provider
Same criteria as
above with exception that privileges are under supervision and require
co-signature by a privileged providers (includes physician assistants,
students, health care providers under probation or in training).This is different than a technician.
What is a
Non-privileged health care practitioners who are
specifically trained to perform a specific procedure or task under supervision
by a licensed and privileged practitioner.
assistants, medical technicians, physical therapy assistants, occupational therapy
All health care providers who provide care at hospitals
and medical centers must be credentialed. Credentialing is conducted by the
hospital credentialing services/department which verifies the employee’s
references, employment history and educational requirements have been
satisfactorily met and that the provider is properly trained for clinical privileges.
Once the practitioner has cleared the credentialing committee’s review process he
or she is then granted clinical privileges to perform their requested skill
set. Not all credentialed providers are given clinical privileges [e.g.
students and residents in training, or health care practitioners specifically
trained to perform a specific procedure (e.g. technicians) and supervised
health care practitioners].
Once you are granted clinical privileges, you are a
privileged provider.Or, you could say,
your hospital has “credentialed you as a privileged provider”.
Clinical privileges are spelled out on the form/paperwork
you are given as part of your entry into hospital service.This is often called a “delineation of
privileges are granted “on trial” for the first year.If no grievous offenses or medical
mismanagement occur, the privileges are renewed for 2 years.Then, the provider fills out paperwork to
renew every 2 years while a hospital employee.These renewals are when you provide your credentialing department what
they require (may vary by job and hospital a bit), but are generally:continuing education verification,
certification renewals, CPR and related mandatory certifications renewals,
state license renewals. These processes are referred to by The Joint Commission as focused professional practice evaluation (FPPE) and ongoing professional practice evaluation (OPPE).
Process of Becoming Credentialed and Granted Clinical Privileges
When an employee is hired and eligible for clinical
privileges, the employee’s paperwork goes before the hospital’s “credentialing
committee”.This committee is often made
of the medical center’s department heads and the hospital’s subject matter
experts in the fields related to the new employee’s field of work.This committee meets on a regular basis.Every hospital varies on this.The committee may meet weekly or
monthly.When the committee meets they
review or (if a modality or field entirely new to the hospital) create, based
on the new employee’s position description.During this review a “delineation of clinical privileges” is
created.It is then approved by the
local subject matter expert (SME) in the field and handed to the new employee’s supervisor.This supervisor then reviews the “delineation
of clinical privileges” with the new employee, they both sign the form.This form goes in the employee’s file at the
Adding to your
granted privileges at a facility
This is an old tradition for physicians.For example, a physician, Jane, takes a
continuing education course on a new procedure.Jane wants to practice the new procedure at the hospital.So Jane follows her hospital’s process for “adding
clinical privileges”.This usually
involves paperwork about her class she fills out, she may need to pass some
hands-on competency training to prove she is qualified in the new procedure,
and her request for this additional clinical privilege is passed on the
credentialing committee.The committee
reviews her request and paperwork.The
committee determines whether or not to grant her the new privileges.If they do, a new “delineation of clinical
privileges” or “addendum” is added to her “delineation of clinical privileges”
paperwork at the credentialing office/department.
In the modern hospital, this is a process that any
privileged provider can follow to add to his or her scope/work in their facility.
Keep in mind the credentialing department is governed
locally by hospital policy and state law.It is also governed by federal regulations which include, when
applicable, HIPAA, privacy laws, and The Joint Commission.When it comes down to nuts and bolts,
credentialing prefers two main aspects:
of least resistance
2.The path toward greatest Quality Assurance objectives
(the more measures of quality assurance, the less the liability the facility
privileged providers are able to work independently (without direct or indirect
practice supervision) to diagnose, treat, and manage a health condition.
2.All health care practitioners who work in a
hospital setting go through their hospital’s credentialing process as part of
the hospital employee hiring process.Not all are granted clinical privileges (“privileged provider” status).
of Credentialing Process:
Anna applies to a job posting for an Acupuncturist at
Helping Hospital.Anna is the first
Licensed Acupuncturist at Helping Hospital.Anna is hired.Since she is a
“clinician”, her hiring packet is turned over from Human Resources to the
credentialing department does not have a process in place for an “Acupuncturist
clinician”, so the credentialer takes the employee packet to his department
head.The department head, Mr. John, is
through and interested in a challenge.He decides, with enthusiasm, to create a path for this Acupuncturist to
work, per her job posting description, as a “practitioner of Traditional
Chinese Medicine, evaluating patients, making appropriate referrals,
recognizing red flags, developing treatment plans”.
Mr. John’s thought process:
language categories the position as an “independent practicing provider” and "licensed independent practitioner (LIP)".
Commission standards on independent providers, credentialing, and privileging:
i. "An 'LIP' is a licensed independent practitioner, defined as an individual, as permitted by law and regulation, and also by the organization, to provide care and services without direction or supervision within the scope of the individual's license and consistent with the privileges granted by the organization."[TJC's WhoWhat . . . of Credentialing"related LIP blogpost]
b.Generally, health care providers qualify as
independent providers and are eligible for granting of privileging with the
following general guidelines:
2.Is there an occupational code for
Acupuncturists?If there is, it would
greatly simplify my work of creating a credentialing packet for this employee.
he found:Yes, there is.
b.Occupational Code.U.S. Department of Labor, Bureau of Labor and
ii.Group 29-0000 is the major group, “Healthcare
iii.Group 29-1000 is the minor group, “Health diagnosing and treating practitioners”
[This is another check in the box for eligibility for granting of clinical
iv.Also, Mr. John notes, BLS O*Net lists the
occupation as “Job Zone Five:extensive
preparation needed”.This again verifies
his path of “independent practitioner” and “eligible for clinical privileges”.
3.What certifications does this Acupuncturist
have?What are the standards in this
field?Are there national
standards?What is the state law scope
of practice?Does she have a state
license in her field?What is it?
John looks over Anna’s resume.On her
resume she notes she has NCCAOM® board certification, a “Diplomate in Oriental
is a certification, Mr. John notes.He
does an internet search for “NCCAOM” and finds
i.National Certification Commission Acupuncture
and Oriental Medicine (NCCAOM®).
1.Mr. John notes—a national certification standard.Quality assurance points here!
“Okay,” thinks Mr. John.“Well, the most useful pieces I have found and learned from so far for
what I need to do in creating this credentialing packet and creating a path to
credentialing and privileging for this independent practicing health care
provider have been the (1) occupational code and (2) the NCCAOM® website’s
4.“Now I need to check in on state scope of
practice and license”, Mr. John thinks. “Does she list her license on her
resume?”He goes back to her resume and
notes her license.She lists it as “East
Asian Medicine Practitioner xxxx, Washington state, expiresxx/xx/year”.The facility, Helping Hospital, is located in Washington State.So, Anna already has a local license.Since Mr. John is familiar with looking up
licenses on the state site, he enters her license and follows the links.One of the links takes him to the state scope
of practice law (revised code of Washington or RCW) for her field, East Asian
Medicine Practitioner.He reads it and
notes how it compares to her hospital job position description, the federal
occupational code, and the national standard.
5.What other quality assurance standards can apply
to this job position and thereby the credentialing packet?
a.General:CPR, bloodborne pathogen training, state
i.He notes in her resume her CPR certificate is
ii.Mr. John notes her NCCAOM® certification
includes a specialized Quality Assurance training and certificate in needle
safety and bloodborne pathogen safety, called Clean Needle Technique.He adds this information to his paperwork.
6.Aha!I have the information I need, says Mr.
John.He sits down with the following
information to create her credentialing packet and from there a draft of
recommended clinical privileges list (to be brought before the credentialing
committee for revisions and approval):
scope of practice
Board certification (NCCAOM®)
i.Includes the quality assurance standard of Clean
Needle Technique and blood borne pathogen training