Importance of Credentialing in Healthcare

Importance of Credentialing in Healthcare

We understand that proper credentialing is an essential component of any functioning healthcare facility. To ensure that daily operations run smoothly, administrators must understand what credentialing is, how it is performed, best practices for credentialing, and the time and resources that may be required for fast and effective provider credentialing.

A Brief Overview of the Credentialing Process

Let’s go over the basics of the credentialing process before we look at real-world examples of why provider credentialing is important for healthcare facilities.

Healthcare credentialing is the process by which a healthcare facility verifies the qualifications of prospective medical practitioners. When hiring Licensed Independent Practitioners, or LIPs, this verification process is especially important.

The legal definition of who can practice as a LIP varies by state, but it usually includes people who hold the following credentials:

  • Medical degrees
  • DO diplomas
  • Doctoral degrees
  • Doctorates in psychology

What you’ll need to check a Person’s Credentials

  • Name, date of birth, mailing address, and phone number are all basic information.
  • Personal information such as gender, ethnicity, and social security number
  • Immunization records
  • Evidence of a positive drug test
  • A complete history of any previous malpractice claims, lawsuits, sanctions, or other disciplinary actions
  • a number of peer references
  • Number of National Provider Identifier (NPI), username, and password
  • Evidence of ongoing medical education at an accredited institution
  • Evidence of a current professional liability insurance policy

The Duration of the Credentialing Process

Completing a thorough credentialing process for a single prospective hire can frequently take three to six months, if not longer.

2 Weeks can pass with little progress when there is so much paperwork to gather and so many institutions to contact and request records from.

With so much documentation to go through, even a three- to six-month time frame with days or weeks of inactivity can feel like a scramble. Because of the time and resources required for even a single credentialing process, one of the credentialing issues in healthcare is that many facilities struggle to maintain a full and honest commitment to their verification processes.

Many healthcare facilities invest in the services of a Credentials Verification Organization, or CVO, for these reasons.

What is the significance of credentialing in healthcare facilities like yours?

Whether your healthcare facility is private or public, large or small, general or highly specialized, speed, accuracy, and completeness should always be a top priority.

These are just a few of the main reasons why you should value your facility’s credentialing practices and take steps to ensure they’re done correctly every time if you want your healthcare organization to continue to succeed or even grow.

1: Credentialing Builds Trust

Patients who lack trust are less likely to be open and honest with doctors about their medical histories, current concerns, disease signs and symptoms, and so on. They are also less likely to adhere to post-care treatment plans.

When patients believe that their doctors and other medical personnel with whom they interact are fully qualified to perform their jobs professionally, they are more likely to trust the healthcare system and cooperate with practitioners.

2: Earning Money Requires Credentials

Partnerships with health insurance companies generate revenue for both healthcare facilities and individual medical practitioners. A payer contract is a contract between a healthcare provider and an insurer (or payer).

There are clauses in payer contracts that determine how facilities and practitioners will be reimbursed by insurance companies for the patient care services they provide, among other complications.

Practitioners must have all necessary credentials, according to payer contracts, in order for their services to be covered by the agreement and paid for. Therefore, you run the risk of exposing yourself and your practitioners to financial losses if your medical practice skimps on the credentialing procedure

3: Credentialing Aids in Reducing Medical Error Rates

4 These mistakes consist of:

  • Miscommunication
  • Prescription mistakes made on doctor’s orders
  • Negative drug reactions
  • Patient medical records that are not complete
  • Crowded establishments
  • Vacant clinical spaces
  • Poorly managed and overly complicated workflow patterns

4. Credentialing shields you from legal action.

In court, it will be crucial to have a complete and accurate record of each practitioner’s credentials. By demonstrating that you checked every single healthcare provider’s credentials and updated the checks as necessary, you can help protect yourself and your institution from liability in the event that a malpractice claim is made against a healthcare provider working in your facility.

You’ll not only protect yourself from liability but also save money by avoiding expensive court-related fines.

5: Having Credentials Improves Reputation

As the populace becomes more tech-savvy, this practice of researching and reviewing is growing in popularity—and becoming more crucial for healthcare facilities to take into account.

Individual healthcare providers and healthcare facilities must uphold a favorable online reputation in order to achieve this. Medical credentialing services is a quick and efficient way to demonstrate a person’s absolute qualification to provide patient care services, enhancing their reputation.

What is Medical credentialing?

The process by which healthcare organizations evaluate & approve doctors and other practitioners to provide care within their networks is known as medical credentialing.

  • Typically, a credentialing application needs:
  • Complete academic records and transcripts
  • extensive work history
  • DEA registration, current medical license, and board certification
  • current records of one’s medical history and vaccinations
  • evidence of ongoing malpractice protection
  • references, both personal and professional
  • complete explanation of any historical gaps or other anomalies

Work of Credentialing Services

To ensure that the credentialing process goes as smoothly as possible, a credentialing service organizes & manages credentialing applications for physicians and other stakeholders.

Three main categories of services are typically offered by credentialing services to practitioners:

  • services for initial credentialing
  • Re-certification services
  • administration of “expiable”

Depending on where you are in your practise and career, your own credentialing requirements may change. Credentialing is undoubtedly a crucial step in starting a practise, and if you’re just getting started, you’ll also be submitting your first applications for credentialing. If you have been practicing for a while, maintenance and renewals will be the majority of your needs.

Avoid Credentialing Pains

The overly complicated payer contracts add a great deal of pressure to the already challenging steps in provider credentialing. Insurance companies frequently go against your best financial interest by trying to force you to comply with their requirements for certifying your practitioners.

contributor
Practolytics is a 20+ year old healthcare technology and management company. We partner with healthcare practices to provide end-to- end solutions including medical billing, healthcare consulting and practice analytics, allowing practices to eliminate revenue cycle management inefficiencies. Our diverse background in every aspect of healthcare allows us to maximize revenue and consistently deliver optimum results.

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