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Credentialing Simplified: Essential Tips for Healthcare Practices

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December 18, 2024

Credentialing Simplified: Essential Tips for Healthcare Practices

Patient safety relies on thorough credential checks. Yet, even big healthcare firms struggle with this. Hiring new staff becomes tough.

It's like hitting a moving target. Getting details right is key. This avoids payment issues and rule breaks. Even top companies face challenges. They work to balance thoroughness and speed.

Today’s healthcare demands both quick and accurate checks. The goal is to provide quality care while swiftly vetting a changing team.

Next, we'll talk about why credentialing matters and offer tips to make it easier.

 

What Is Credentialing?

Credentialing checks the abilities and history of healthcare providers. It verifies that a provider is trained, licensed, and skilled at giving medical care.

Besides being a legal must do, credentialing also serves as a protector. It ensures good care and shields patients from unfit practitioners.

 

Why Credentialing Matters?

Payers carefully check healthcare practitioners' qualifications to ensure high standards. Poor credentialing can lead to:

  • Payment denials

  • Wasted resources

  • Bad patient care

A 2021 Medical Group Management Association (MGMA) survey found that 54% of practitioners faced more rejections due to credentialing issues. This highlights the need for better processes.

 

The Importance of Simplifying Verification

Healthcare groups should make verifying licenses and certifications easier. This is crucial for: ·

  • Trusted, top-notch treatment

  • Avoiding expensive issues

We need to improve the process of checking credentials to meet what insurance payers ask for. It's vital for high-quality care in a challenging healthcare setting.

 

The Growing Challenge of Credentialing Denials

The number of credentialing rejections is rising. This increase is due to changes in procedures, rules, and frameworks by various entities.

Healthcare providers are under more pressure. Their administrative load is already heavy. The American Hospital Association reports they spend about $39 billion each year on compliance.

But when credentialing jobs are missed, it leads to:

  • Refusal of payments

  • Time loss for healthcare providers

  • Rising annoyance for all involved parties

 

Tips to Simplify Credentialing

Start the Licensing Process Early

Begin the licensing process for new practitioners as soon as you can. Requirements vary by provider type and might take months.

Physician Assistants (PAs) must get certified by the National Commission on Certification of Physician Assistants. This process includes verifying education and obtaining peer references.

 

Keep Contact Information Updated

Keeping all providers' contact information current is vital. Outdated details can delay credentialing and block communication with payers.

  • Check your information often.

  • Update it as soon as changes occur.

  • Make sure all details are accurate.

 

Outsource Credentialing Services

Think about hiring a service like Extended Healthcare Services for credentialing. They can handle it for you.

Why Outsource Credentialing?

  • Fewer mistakes

  • Accurate records

  • Saves time and money

By outsourcing credentialing, you can focus on your core business while experts handle the details.

 

Understand State Regulations

Credentialing requirements differ from state to state. If your organization works in multiple states, follow these steps:

  • Ensure providers meet each state's criteria.

  • Check for any specific regulations.

  • Stay updated on changes to the laws.

Following these steps will help you avoid payment processing issues.

 

Track Credentialing Applications

It's important to track the progress of your submitted applications. Always follow up with insurance companies about any missing information. Be aware that delays can happen due to incomplete submissions.

 

Avoid Common Errors

Be meticulous to prevent errors that can derail the credentialing process. Common mistakes include:

  • Missing teammate reference contacts

  • Incomplete forms

  • Expired National Provider Identifier (NPI) or Drug Enforcement Administration (DEA) numbers

  • Missing malpractice history

  • Data entry errors

 

Maintain Digital Credentialing Files

Store all credentialing documents digitally for easy access. This includes:

  • Diplomas

  • Licenses

  • DEA numbers

  • Other essential credentials

Keep these documents in a centralized digital repository.

 

Obtain Dedicated DEA Numbers

Providers must have DEA numbers to prescribe medications. These numbers are specific to each state. The application process can take several weeks.

  • They differ from state to state.

  • Allow weeks for application processing.

Plan ahead to prevent any delays!

 

Ensure NPI Accuracy

To maintain quality, it is crucial that NPI information is accurate and current.

Make sure to update the National Plan and Provider Enumeration System (NPPES) as soon as there is a change in a provider’s status.

 

Document Clinical History

It is important to keep detailed procedure logs and clinical history on file. These records are often necessary for verifying work history during the credentialing process. Remember to:

  • Maintain accurate procedure logs

  • Document clinical history thoroughly

  • Ensure files are organized and accessible

 

Examine Malpractice Claims

It is important to keep a complete record of malpractice claims. Here are some key points to remember:

  • Include insurance certificates and policy details.

  • Ensure new providers have their malpractice insurance documentation on file.

 

Use Advanced Credentialing Software

Think about using software for managing credentials. It keeps track of expiry dates and checks provider qualifications. The best options also warn you about upcoming renewals. This way, your credentials stay current.

Credentialing Made Easy for Healthcare Providers

At Extended Health Services, we enhance the credentialing system for healthcare workers. Our name stands for precision, speed, and reliable help.

We will set your practice on the path to success. We will use advanced tools, custom plans, and skilled employees. You will be free from credentialing confusions.

We manage all, speedy approvals to compliance tasks. It allows experts to concentrate on looking after patients.

Count on us to cut paperwork, improve payor relations, and find new revenue sources. We're with you at every step.

 

The Bottom Line

Upgrade your healthcare practice with better credentialing. This reduces errors and payment issues, and it also improves patient care.

It's important for everyone, from small clinics to big networks. It ensures compliance and smooth running.

Use planning and technology to facilitate administrative tasks. Pay attention to details to improve workflows.

Good credentialing lets your team focus on care. Use these strategies to stay efficient in today's complex healthcare system.

 

FAQs

Q: What common mistakes can delay credentialing?

Errors slow down and complicate the process. Common problems are incomplete forms, wrong contact information, missing insurance records, and expired licenses. Paying attention to detail avoids these issues.

Q: How does outsourcing credentialing help?

Outsourcing brings you peace of mind. Experts handle the work, and you reap the benefits. It saves time and reduces errors. Your team can then focus on patient care, not paperwork.

 

Reference

https://www.aha.org/press-releases/2017-10-25-new-report-shows-regulatory-burden-overwhelming-providers-diverting

https://www.ncbi.nlm.nih.gov/books/NBK519504/  

https://www.mgma.com/mgma-stats/more-than-half-of-practices-report-credentialing-related-denials-on-the-rise-in-2021

 

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