Standardization and following best practices during the credentialing process will help ensure that your healthcare organization remains dedicated to patient safety and also signifies the commitment to providing high-quality medical care.
Implementing standardized procedures and adhering to best practices in the credentialing process ensures your healthcare organization remains committed to patient safety and demonstrates a dedication to delivering high-quality medical care. Organizations that do not thoroughly complete the credentialing process risk jeopardizing patient safety, exposing the practice to litigation, and potentially incurring revenue loss.
Establishing strong policies and procedures regarding the organization’s credentialing process is imperative to ensure adherence to all regulatory agencies as well as adherence to your organization’s own standards. Providing your credentialing staff with the tools and policies necessary to avoid costly delays, redundancy, and most importantly, quickly identify and resolve any red flags encountered during the credentialing process.
In an era where healthcare organizations are striving to control operating costs, limited staffing resources can make the credentialing process a significant source of pressure for both staff and the practice’s finances. However, here are a few tips and best practices that can help your organization save valuable time and money when credentialing:
1. Initiate the credentialing process early.
To prevent employee stress and avoid costly errors. Establish a clear credentialing policy that specifies how far in advance to begin the process and outlines a timeline for completion. Although the credentialing process may vary for each provider, setting well-defined goals is essential for ensuring compliance and standardization of your credentialing process.
2. Have a thorough initial application.
Potential providers should start by filling out a comprehensive application detailing their education, training, work history, and any specialized skills.
3. Establish a good training program for your credentialing staff.
To ensure employees are completing credentialing applications accurately, timely, and adhering to best practices. Any delays in the process ultimately equate to a loss in revenue for the practice. Staff who are well-trained, proficient, and knowledgeable regarding your organization’s credentialing policies will help reduce errors and ensure compliance. Furthermore, credentialing staff who are well-versed in the credentialing process will be more likely to spot any deficiencies early on or identify red flags during the process.
4. Collect and verify any documentation right away.
This includes diplomas, licenses, certifications, and proof of malpractice insurance. According to the National Association of Medical Staff Services (NAMSS), primary-source verification is considered best practice and will help ensure your organization remains in compliance. Primary source verification helps ensure your organization remains compliant with state and federal regulations, as well as accrediting organizations. NAMSS states that “healthcare organizations should make every effort possible to primary-source verify all practitioner-credentialing elements whenever possible. If the primary source is unresponsive to material requests, the applicant is responsible for contacting the primary source.”1
5. Get peer references. Ask each provider to submit names and contact information of those who can attest to the provider’s competency. According to NAMSS, best practice would be to ensure all professional references “be an individual from the same professional discipline and/or license type.”1
6. Know when to outsource. Credentialing is a time-consuming process, and many practices do not have the time or resources to commit to credentialing. Outsourcing to an organization that has experienced staff to handle all of your credentialing needs may be the best and most cost-effective means of managing provider credentialing. A third-party vendor will be able to help your organization by managing all the documentation requirements of credentialing while tracking the application status. In addition, credentialing maintenance can be even more time-consuming and arduous. An experienced, efficient, and highly organized credentialing organization can help prevent the costly mistake of preventing expired credentials. These organizations also have the staff and resources to keep updated on any regulatory changes and best practices in the industry.
7. Stay updated on requirements. If your organization prefers to handle credentialing in-house, ensure your staff stays updated on state and federal changes to credentialing requirements. This will help avoid delays and, most importantly, maintain compliance. In addition, have your credentialing staff regularly review and update the provider’s credentials to ensure they remain in good standing.
Failing to credential or properly maintain provider credentials can have significant financial repercussions for the practice and may needlessly expose it to scrutiny by regulatory agencies.
The substantial administrative burden of credentialing can greatly affect a healthcare organization’s financial performance. For medium to large-sized practices, improper credentialing, delays in credentialing maintenance, or unresolved credentialing issues can lead to annual losses that easily surpass hundreds of thousands of dollars. Additionally, these inefficiencies can strain staff resources and negatively impact patient care quality, further compounding the financial and operational challenges faced by the healthcare organization today.
How BlueStone Services Can Help
BlueStone Service’s Medical Business Advisory Team is here to help you streamline your credentialing processes. Don’t leave valuable revenue dollars on the table with an unoptimized credentialing process. Contact us today to get started on improving your credentialing process.
