Changes In Physician Credentialing Process

Just recently there have been some interesting changes in legislation concerning health care. New regulations require behavioral health programs to upgrade the standards of credentialing and provide the credentialing process differently.

Before you start worrying how your team is going to handle even more credentialing work, let's have a look at these changes and consider it as an opportunity to improve your administrative process.

How does it change behavioral health programs?
Those health facilities that didn't have licenses must obtain different certificates. Therefore, the following programs now must credential their providers:
• Nonresidential programs, such as day treatment, intensive psychiatric rehabilitation treatment, partial hospitalization, and PROS(personalized recovery oriented services)
• CPEPs (Comprehensive psychiatric emergency programs)
• Hospitals for mentally ill persons
• ACT programs
• Psychiatric inpatient units
• Treatment facilities for youth
• Apartment program

There is also new Medicaid Carve-In that should improve health outcomes, quality of care, and reduce healthcare costs. Medicaid will implement managed-care model instead of fee-for-service model. Within this model, Medicaid will:
• Provide necessary recovery-oriented services
• Ensure individual-centered care management
• Make outcome-based payments
• Provide client choices
• Improve behavioral health services
• Track behavioral health spending

Now, there are Health and Recovery Plans available for people who need significant mental support. To be able to administrate HARPs, a hospital has to increase credentialing requirements and ensure the program has:
• Adequate network
• A process that can handle the new credentialing process
• Experienced staff
• A compliant credentialing process

There is going to be a data management platform that allows hospitals to manage and maintain information about the credentialing process. The main thing you should do to meet the requirements is to constantly update data on the platform. Specifically, answer the following questions to maintain adequacy requirements:
• Is the hospital accessible to the clients?
• Are your providers able to meet the needs of patients?
• Can your patients understand what your providers tell them?

There is a simple solution that helps hospitals meet new credentialing requirements: new software. There are software systems that help handle data collected during credentialing processes. Usually, one system is enough to manage all paperwork. Note that this software can cost quite a lot and may not have a user-friendly interface. However, nowadays almost every person is technologically savvy and can quickly get acquainted with new software. Moreover, modern software is easier to manage and has improved interface.

The credentialing process serves both patients and providers, and physicians have the right to expect recognition of their efforts, so they need to provide relevant information that reflects what they really do in practice. Lots of feedback has been provided concerning unnecessary difficulties during the process, so we can expect further changes that will make everything a lot easier. For now, there are still lots of costly applications and time-consuming processes that physicians have to go through every 2 years.

Premier Credentialing Solutions, LLC has the best credentialing and licensing solutions for you and your business; We proudly offer Provider Enrollment & Physician Credentialing, Medicare – Provider Enrollment & Revalidation, Medical Licensure Services, and Full-Service Credentialing For Billers / Billing Companies. Call (800) 455-4773 for a free, no-obligation consultation.