How To Effectively Manage Credentialing Process

How To Effectively Manage Credentialing Process

Ensuring that your providers are credentialed is the crucial part of saving the practice. From education background to clinical research to board certifications, a lot of data must be collected and verified for each physician to confirm that they meet necessary qualifications of a healthcare specialist.

Have a look at the new recruit's data

When you're recruiting, try to align the credentialing process and the recruitment. Most employment contracts are built on the fact that the employer should get credentialed, thus if the physician doesn't get credentialed, that's a disaster for all parties. The leader of the hospital is 6 months behind in hiring a new physician and reputation is ruined for bringing a provider who can't meet the standards. The new physician may have relocated the job and waiting for a paycheck that will never come. Besides, he can even sue the group for failing to provide the promised job. And when providers don't get credentials, private insurance companies, Medicaid or Medicare can refuse to pay for certain procedures, reducing your incomes. Therefore, its leader's responsibility to check all physician's references, background information and demand explanation for any questionable data before offering the job.

By reviewing all gaps in employment, malpractice issues and references you can make sure the physician won't have problems with the credentialing process. Sometimes, credentialing committees ask for additional information and explanations. It can be asking simple questions about any given reference, or reviewing malpractice suits. The committee can also send documents to a third party for an independent check.

Keep all information in one place

Get credentialing software to keep all information secured inone place and allow staff to view the credentialing process and tasks that need to be completed. With provider's data and supporting forms connected in a single accessible record, your staff can rapidly provide and update their information. Besides, many different credentialing programs notify you about licenses that are near expiration, so you can proactively manage re-credentialing process as well.

Hospital credentialing is not the easiest process to complete, but at least it is more serious and organized now than it was before. However, new physicians still have to provide all applications and forms during the process. And hospitals must protect their patients. It's their responsibility (even though they have to rely on physician references), and hospitals can get sued over poor credentialing or end up in a court when a physician has its privileges removed.

What are the chairman's responsibilities during credentialing process?

It's chairman responsibility to investigate all the skeletons. If you're recruiting a physician who has some questions on the records, devote some time and get all the details explained, so that you won't have to fight problems during the credentialing process. If there is something that looks like regret, now it's time to search for another recruit. But if you still believe that the physician provides quality care, spend some time discussing all the problems with the credential committee to see what they need in order to finish the credentialing process.

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.