Privileging
Privileging grants a credentialed provider permission to perform specific procedures at a specific facility. It is about scope, not about payment.
Updated
Privileging is a facility's decision about what a particular provider may do within its walls: which procedures, in which settings, under what supervision. It follows credentialing — the facility first verifies who the provider is, then decides what they may perform there.
It is granted by the facility rather than by a payer, and it is specific to that facility. A provider privileged at one hospital is not thereby privileged at another — with one regulated exception: for telemedicine furnished under a written agreement, a hospital's governing body may grant privileges relying on the credentialing and privileging decisions of the distant-site hospital or telemedicine entity, on conditions the regulation sets out. The Medicare conditions of participation also put a floor under the decision from the other direction, requiring that staff membership or professional privileges are under no circumstances “dependent solely upon certification, fellowship, or membership in a specialty body or society”.
In practice
Privileging belongs to the clinical side rather than the revenue cycle, which is why it is easy to conflate with the enrollment questions around it. It does not make claims payable, and being fully privileged at a hospital says nothing about whether a payer will pay for the work done there.
Commonly confused with
- Credentialing: Credentialing verifies qualifications; privileging decides what those qualifications permit at a given facility.
- Provider enrollment: Enrollment is about a payer paying claims. Privileging is about a facility permitting work. Neither implies the other.