How To Choose The Best Physician Credentialing Software

How To Choose The Best Physician Credentialing Software

The current shift from fee for service to fee for quality has attracted bigger audience to health management. Those healthcare organizations who want to ensure efficient clinical delivery base should have started consolidating clinical providers at higher rates. Hence, new credentialing software is needed to handle all the complexities of multi-provider, disturbed, quality driven reimbursement model. The proper credentialing software has to offer are venue-centric solution and help healthcare organizations meet their financial and operational needs that healthcare management requires.

24/7 accessibility

Before buying credentialing software, go through all its features and evaluate if it can perform everything you need. At the very least, it should have 24/7 accessibility, so you can get your credentialing data at any time. All information should be stored in the cloud where healthcare managers can identify where they are in the credentialing process and ensure you aren't losing revenue on delayed applications. Moreover, being in a cloud means a reduction in capital expenditures since there is no need for another software, servers and hardware to subsidize the credentialing system.

Financial performance and payer operational metrics

Another important feature is institutional, financial performance and payer operational metrics. It means that leaders and managers of a healthcare institution can identify how the facility is performing from the financial and operational perspective. It also allows evaluating provider's individual performance. As any leader knows, understanding performance of providers is the first step of improving financial performance.

Generated work list capabilities

As a leader of a healthcare facility, you should require system generated, flexible work lists that your staff can use to meet their credentialing demands. No more calendars and post-in notes that remind you about stages of the credentialing process. The efficient credentialing software will help you go through each step quickly and without mistakes. Besides, healthcare leaders can easily evaluate the work of their providers and establish different metrics.

Assurance tools and mechanisms

The ability to track and monitor credentialing processes of the providers is a necessary feature of credentialing software. Quality monitoring and staff training should be ongoing, don't just leave it be.

Productivity tracking tools

Credentialing software should be able to track statistics and productivity metrics. What is your staff doing on a weekly, daily, or hourly basis? Are these just miss-guided, pointless efforts? The ability to track productivity metrics makes providers more efficient and ensures you're not losing revenue.

Combined credentialing concepts and revenue cycle

Understanding financial impact of the credentialing process helps meet the demands of health management initiatives. And when you know the impact, you'll see if you're losing revenue because providers aren't credentialed properly.

Revenue management

Credentialing software should give you suggestions that help ensure profits and sustainable growth of the facility. Keep all the processes streamlined and build a close network to keep your facility going.
Investing time and money in advanced credentialing software is always a good idea. Otherwise, you risk facing credentialing denials and lost revenue.

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.

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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.

Physician Criteria For Privileging

For many years, hospitals throughout the country have granted privileges using so-called laundry lists. Laundry list or privilege list is a detailed checklist that shows procedures and treatments that physicians can request to treat patients or perform these procedures. The American College of Surgeons was the first who recommended laundry lists because many physicians had not finished an approved residency programs in a certain specialty area. The laundry list has gone through modifications but remains in use to the present time.

Nowadays, almost all physicians who apply for privileges have completed a training program and the original use of laundry lists is no longer relevant. However, even though the privileging process is easier now than before, laundry lists are a common approach to the delineation of clinic privileges in many hospitals.

Laundry lists include not only procedures and treatments available at the hospitals, but also criteria that must be met. Thus, physicians check off procedures they would like to be allowed to perform and go through criteria for each procedure. When using the list, physicians don't have to provide documentation of experience and training to show that they are qualified for all privileges. Physicians are allowed to choose which criteria they can meet before applying for privileges.

Those hospitals that don't have laundry lists use criteria-based privileging. It combines predefined criteria with well-defined, realistic privileges. The term core privileges mean clinical activities within a certain specialty that any actively practicing, properly trained physician with good peer recommendations would be able to perform.

At hospitals who use the criteria-based privileging system, those physicians who meet predefines criteria can apply for privileges, and those who proved additional training and experience can apply for noncore privileges. Special privileges almost always correspond to one of the following:
•    volume-sensitive diagnoses
•    new advances in technology
•    high-risk treatments

If a physician meets required criteria to request privileges are supported by references attesting physician's competence, privileges can granted.  If a physician requires additional privileges, a separate verification procedure is required. The same is true for performing unusual treatments and procedures - for example, what would otherwise be a basic procedure, like a surgery, with a robot instead of a doctor require the separate privileging procedure.

Physicians who can't meet predefined criteria in a particular specialty may still be qualified for limited privileges by providing honest evidence that they possess proper training and experience to perform the requested procedures or treatments.  For example, a family physician can apply for a specific set of privileges on the obstetric list, for example, to perform the cesarean section. But to get the privileges, that physician would have to show to the hospital credentialing committee that he/she has required training and experience that is necessary to get privileges and perform cesarean sections.

One of the main advantages to the criteria-based privileging approach is consistency. All physicians are asked to meet the same standards and prove that their education, experience, training, etc., are suitable for the privileges they'd like to get.

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 The Difference Between Credentialing And Contracting?

If you're a health department that wants to start a billing program or is going to expand, you have probably heard the terms Contracting and Credentialing before. These are very important steps that you have to complete, or you can't bill private insurance companies for services your hospital provides, losing a huge part of revenue. But what these two terms mean and where should you start?

The main points of credentialing

Local health facilities can start billing insurance companies only after they've got credentials. Credentialing is a process that private insurance companies use to verify, obtain, access, and validate a healthcare facility in order to ensure it's a reliable place and for liability purposes.

The start of the credentialing process, create a file folder for an insurance company. Different companies require different documents and forms, and folders will save your time and help you to simplify and organize the process for every payer. To choose the best insurance companies among many others, try to create a survey and ask your clients about their companies to see which are used the most. The most common ones should be among the first ones.

After you have created the list of companies to get credentials from, you'll need to get acquainted with the requirements for every company. Each insurance company has a web page where they state all necessary forms and requirements. From there you'll get all relevant information, provide all documents and fill out all forms. Submit everything you get, and you should get credentials within 180 days. And when you're credentialing, it's time to think about contracting with companies.

The main points of contracting

Contracting refers to the process of creating agreements with private insurance companies to become one network with them. It includes establishing services covered, rates, payments, and other information with each company. Every company requires a separate contract.

If you find credentialing process hard, then you should know that contracting is much harder. You will have to negotiate a lot of things with all insurance companies and your success depends on talking to the right person within each organization. You can try to speak to directors and administrators who have some useful contacts to make the process easier.

In today's world of revenue cycles and health insurance, it's important to remember that improper credentialing may lead to serious consequences, such as denied or delayed reimbursement for services provided. Even worse, it may lead to consequences in terms of compliance violations, which means criminal charges and monetary damages.

Some payers take a long time to get to your case and you may face multiple delays. They arise from the non-standard language some organizations use. Sometimes you will have to work with payers to revise the language. It will require even more time.

Healthcare payers often don't know much when it comes to understanding what billing services what local organizations provide. So, it's always a good idea to be persistent and remind them from time to time that it's very beneficial to contract with your 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.