Credentialing, Licensure, Certification, Accreditation: What’s the Difference?

Within the medical arena it seems like the terms credential, license, certification, and accreditation are used frequently and interchangeably. As an accrediting body, the AIUM wanted some help in showing and explaining how these terms differ. Luckily credentialing expert Mickie Rops, CAE, agreed to help out. In this post, she explains the differences.aium_accred

  1. Credentialing: Process by which an agent qualified to do so grants formal recognition to and records such status of entities (individuals, organizations, processes, services, or products) meeting pre-determined and standardized criteria. Credentialing is the umbrella term for all the types of programs like the ones that follow.
  2. Licensure: Mandatory process by which a governmental agency grants time-limited permission to an individual to engage in a given occupation after verifying that he or she has met predetermined and standardized criteria. Licenses are typically granted at the state level and have ongoing maintenance requirements. Associations do not grant professional licensure.
  3. Professional Certification: Voluntary process by which a nongovernmental entity grants a time-limited recognition to an individual after verifying that he or she has met predetermined and standardized criteria. Historically association-based programs, many companies (Microsoft, for example) now offer and manage certification programs. Professional certification also has ongoing maintenance requirements.
  4. Accreditation: Voluntary process by which a nongovernmental entity grants a time-limited recognition to an organization after verifying that it has met predetermined and standardized criteria. The focus of accreditation’s assessment is on safe and effective processes and outcomes. Accreditation usually has ongoing maintenance requirements.
  5. Certificates: A training program, class, or session on a focused topic for which participants receive a certificate after completion of the coursework and successful demonstration of attaining the course learning objectives. While certificates may be dated, once they are awarded, they are awarded. There are no ongoing maintenance requirements.

The AIUM is an accrediting body, which means it recognizes practices, not individuals, that meet its published parameters. These parameters are focused on safe and effective processes and outcomes. The AIUM also issues certificates for those who earn CME credits by attending an event, taking a test, or participating in a webinar. These certificates, however, must be submitted to the entity that issues the appropriate licensee, certification, or accreditation.

Do these terms confuse you? What tricks do you use to keep them straight? Have an questions about AIUM Accreditation?  Comment below or let us know on Twitter: @AIUM_Ultrasound.

Mickie S. Rops, CAE, is a credentialing expert who helps organizations make the right credentialing decisions. She can be reached at www.msrops.com or mickie@msrops.com.

Why 76811 Accreditation?

Starting in 2013, the AIUM and the Society for Maternal-Fetal Medicine (SMFM) co-led a task force of medical societies to explore what distinguished a 76811 examination from the more routine 76805 examination. The result of that task force was the “Consensus Report on the Detailed Fetal Anatomic Ultrasound Examination,” which was published in the February 2014 edition of the Journal of Ultrasound in Medicine.

aium_accredThe report concludes that the 76811 is a distinct examination that requires special expertise. While many obstetricians and radiologists perform the 76805 on a routine basis, the skills and detail required for a 76811 generally require additional training and expertise—frequently through a Maternal-Fetal Medicine fellowship or similar targeted radiology fellowship.

Unfortunately in practice, what constitutes a “detailed obstetrical ultrasound” (or a 76811 examination) varies tremendously. It was for this reason that the AIUM felt it was critically important to promote standardization of what is required of such an examination and work to ensure that individuals performing these are competent and qualified. Additionally, given the move by some payors to reimburse only examinations performed by accredited practices, the AIUM felt it was prudent to have a mechanism in place to accredit practices that would be qualified to perform these examinations before it was directed by the insurers.

To address these concerns the AIUM developed the 76811 accreditation. This new accreditation is an “adjunctive” accreditation for practices that have, or are seeking, accreditation in 2nd/3rd trimester obstetrical ultrasound. It operates very similarly to how 3-D gynecologic ultrasound accreditation is an adjunct to the basic GYN ultrasound accreditation.

If your practice is performing detailed ultrasound examinations for women at high risk of, or who are suspected of having, an anomaly, you should consider adding the 76811 accreditation.

The structure for this accreditation submission is a little different however. Because the consensus statement provided a long list of “always must show” anatomy, and an additional list of “when clinically indicated” anatomy, the accreditation submission must show all of the “always” anatomy on each of the normals, but only needs to show an example of a selection of the “when clinically indicated anatomy” structures on at least one of the studies. In this way, you can exhibit competence getting the views that are occasionally, but not always, needed without having to add a lot of extra views to all of your study submissions.

This newly added accreditation option is live now. The AIUM is excited about letting you demonstrate your expertise so that you can get the credit and recognition that you deserve. Once again, the AIUM is involved in setting the standards for quality, and we know our members are up to the challenge!

Have questions about this new accreditation option? Comment below or let us know on Twitter: @AIUM_Ultrasound.

Dr. David C. Jones is Director, Univerisity of Vermont Medical Center Fetal Diagnostic Center and Professor, Obstetrics, Gynecology & Reproductive Sciences at the University of Vermont, Department of Obstetrics, Gynecology & Reproductive Sciences, Division of Maternal-Fetal Medicine. He serves as Vice Chair of the AIUM’s Ultrasound Practice Accreditation Council.