How to Avoid the Most Common Credentialing Mistakes?

Credentialing process is a necessary part of a successful physician practice with steady cash flow and patient referrals. Avoiding these common credentialing mistakes will make the process move more quickly and efficiently.
Providing incomplete information
The most common mistake many physicians make is a lack of attention to small details. Errors and mistakes in application lead to delays and even denials. Different healthcare facilities may have different application forms, but typically you need to submit your phone, tax, address, services provided, contact information, employment history, copies of licensure, patient profile and legal troubles regarding your practice if you have any.
What can you do? Thoroughly check your application a couple of times to certify its accuracy before sending it to the credential committee. Getting everything right the first time means you get credentialed much faster.
Not following up
Be prepared that your plans can be backlogged with the credentialing process. Do everything you can to confirm that your application was successfully received and know where it is. If something sounds like complete nonsense to you, ask questions and wait for the response. Many physicians have no idea of where in the process their application is and what each stage means. Make sure you have no more questions before accepting the answer.
Follow up from time to time and don't forget to make notes. E-mail your contacts, phone if you need to and check all web directories. Never call to explain delays or notify about updates. The only way for you to find out something about the application is to follow it up regularly. Make it a routine and keep up until your application is approved. Remember that you're the one who is concerned about the process.
Don't allow CAQH lapse
If you already have a CAQH profile, you know that it should be updated regularly. Always keep up-to-date all contact information and re-attest your data. You should act proactively when you receive an updated insurance, license, DEA or any other document and get everything loaded to your profile with new expiration dates. It will help avoid delays in the process of re-credentialing.
Not knowing the standards and guidelines
Application forms in Medicaid, Medicare and other government health programs are completely different. They all have standard forms that must be appropriately filled out and sent to the intermediary. These applications, then reviewed against very strict standards. Many physicians make the same mistakes in the following:
• Using outdated/irrelevant applications
• Using incorrect forms
• Submitting incomplete applications
• Submitting to the wrong intermediary
• Not submitting required forms
• Not using verifiable practice location as a practice address
• Not signing the application in all fields
Not giving enough time
Many physicians start too late and this is a reason for their failure. You really need to give yourself at least 3 months. The responsiveness of your application will be determined by the motivation to add a new doctor to a team and the workload.
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.

What's Important To Know About The Credentialing Process?

Physician's credentials - certificates, diplomas and licenses on the wall - tell patients about their professional skills and qualification to treat them. In the US, professional organizations, state and local governments establish the credentials that physicians need to provide their services.


Practitioners are credentialed and then privileged - healthcare facilities verify education, license, and qualification - upon hire and then every two years. Physicians can get privileges after thorough evaluation and verifications of the training and education they have presented. Privileges allow physicians to give the care treatment and services by the facility to the patients.


The most important thing to know about the credentialing process is that there is no national, standardized system for credentialing physicians. Each state and local government is responsible for deciding what physicians have to provide to get credentialed. Those credentials may vary quite a lot from state to state and among different disciplines.


Patients should note that certificates, licenses, and regulations can't guarantee effective, safe treatment from any physician - complementary or conventional. Tell your physician the complementary health approaches you prefer. Tell them everything you do to take care of yourself. This will ensure safe and coordinated care.


Apart from credentialing, you could also hear about certifying and licensing. Credentialing is the broader term that refers to doctor's license, certification, or education. Professional organizations give certifications, government agencies grant licenses. Note that being certified or licensed doesn't mean being qualified.


The vast majority of states use the approaches below to credential doctors:
•    Title licensure: requires doctors to obtain credentials prior to using a title
•    Mandatory licensure: requires doctors to have licenses to treat patients
•    Registration: requires doctors to provide information about professional education, experience, and training


To get a license, you should carefully read requirements of each state. Among everything else, they may ask you to:
•    meet certification requirements
•    graduate from a certain program
•    pass exams
•    Complete a training program


The services you're allowed to provide also vary from state to state. For example, some states don't allow acupuncturists to recommend diets to patients, while others recommend doing it.


Some professional organizations offer additional certification examinations. Certifications qualify doctors for local or state licensure. For instance, in some states, doctors who don't have an M.D., have to be certified by the National Certification Commission if they want to be licensed.


Educational programs in the US train physicians and prepare them for future certification. The Department of Education authorizes specific organizations to accredit training programs for doctors.


The credentialing processing time varies from one organization to another. Sometimes plans take 6 months to complete the process and then 50 days for contracting, while others need 3 months to finish everything. When you submit documents for contracts, enrollment or follow-up on your application, it's important to keep track of the process by utilizing fax logs, certified mail, and documenting all conversations. Once the credentialing process is complete, you will be offered a contract and will be able to treat patients in the facility.


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.

How Long Does It Take To Complete Physician Credentialing?

It's quite common that a new physician joins your healthcare facility either from another practice or out of residency. It's the time when you have to deal with many managed-care organizations or MCOs, so your new physician needs to be credentialed.

This process requires a lot of time and effort. First, you have to collect all documents from the provider - from valid state license to hospital privileges to confirmation of malpractice insurance. Then you have to wait at least 30 days (but it usually takes longer) for the MCOs to check and verify documentation before the new physician can be added to the panels. During this time, the physician is not allowed to treat your care patients. At least, the physician will not be reimbursed for treating, which dramatically limits the ability of the physician to create revenue for your facility. At this point, many start asking why this process takes so long. Is there any way to reduce delays? Below you can find some tips to help you and your facility.


Why is this process so long?
There are many reasons for delays, but the main ones are MCO's desire to match the NCQA (National Committee for Quality Assurance) standards and inefficient planning on the part of practices and physicians.
One of the NCQA standards that are called the Initial Primary Source Verification stipulates that the MCO should verify several documents, like records of professional liability settlements, prior to assigning credentials. When the MCO really wants to meet this standard, they make withhold credentials from a new physician until the very last detail is verified.

Poor planning is also a popular reason for delays. Quite often, new physicians don't start credentialing process until they arrive at practice, even though they've started filling the applications months earlier. And there can be a huge delay since collecting references can take months and then weeks until they arrive. Until all information arrives at the MCO, an application cannot be considered complete - and while it's not complete, the credentialing process is stalled.

For that reason, many healthcare facilities require submitting application at least 90 days before the physician's start date. The processing time can take less than 90 days, but it's a benchmark since it allows extra time when some documents can't be verified in timely manner or discrepancies is required.

You should just keep in mind that credentialing process will take as long as needed to collect all information, receive board recommendation and verify all sources. It's hard to estimate the minimum or maximum frame for the credentialing or privileging process, which both may take longer than three months. Medical staff bylaws, which define privileging and credentialing processes, specify that applications must be acted upon a certain period of time. Some credentialing applications may be finished faster than others, and it always takes longer if the primary source can't be verified, if a physician omitted information or made mistakes on the application, or if there are red flags that require careful investigation.

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.

Why Is Privileging Important?

 

While we all hope that our doctors have the highest qualifications, there are cases when patients suffer inappropriate care. At many hospitals across the country, where quality care is their biggest concern, medical staff always struggle with the task of properly privileging their physicians.


There are at least two reasons for this. The first one is medical board requirements and rules that vary in each state, making it quite difficult to hire physicians from different states and develop credentialing standards. The second one is that appropriate privileging training has sometimes been inefficient, mainly due to the lack of appropriate healthcare facility's resources and personnel.
However, hospitals still stick to the privileging process and try to make it as easy and quick as possible. Below there are the main reasons for granting privileges, and how to make this process more pleasant.
Understand the importance of the process
Every healthcare facility should understand that no provider can be allowed to provide services until he/she has successfully met the requirements of a privileging process and proved the competence and experience. Hospitals should begin by collecting applications that have all necessary information (for example, certification and training). Then this information should be verified through reliable sources to ensure that this physician data is valid.
Complacency cannot lead the privileging process
The very first goal of any reliable healthcare provider is to deliver the highest quality patient care, thus hospitals have to go through all necessary steps to develop a perfect and clear privileging process and reevaluate and update the process to ensure the best results. Evaluating new physicians and assigning proper privileges can take a lot of time even under the best circumstances. The better your process is, the sooner you'll grant privileges to a physician, thus the sooner he/she will start treating patients and brings you more revenue.
Look outside the box
When you're evaluating credentials applications and files, having everything done properly and get all the documents is quite important, but it is not a guarantee of success. Sometimes physicians don't include information that is as important as data that is included, and it can require a well-trained credentialing expert to get rid of useless information and find important nuances in physician's life and practice.
Appropriately trained credentialing specialist is recommended
Lack of privileging success is quite often due to incomplete, insufficient, or improper resources and personnel. Unfortunately, erroneous or incomplete decisions based on fake information (which results in granting privileges to an incompetent provider) can compromise the quality of patient care. It's really important that a hospital takes all appropriate steps and has the most highly trained staff.
Explain to your staff the importance of privileging process
It's vital that your committee members, physician leaders, board members and senior management understand the importance of privileging. Obtaining their support will kick off the whole process on the right foot and dramatically improve chances for success. For healthcare providers that provide honest information and meet the standards, the result of the process is predictable. And when you get a perfect physician, he/she assures the highest quality care possible.
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.