What is Credentialing and It’s Advantages?

Credentialing (also known as medical credentialing, physician credentialing, or provider credentialing) is the process of verifying a doctor’s background and work history. This includes checking all licenses, certifications, training, residency, and previous education. In other words, it verifies all of a doctor’s credentials before hiring them at any medical organization. This thorough process should begin as soon as a medical facility hires a new doctor. Although it can be time-consuming, it is necessary and should not be overlooked. Here’s a quick rundown of credentialing and how it should be used in the medical industry today!

Check That You Are Following Regulations

When it comes to medical credentials, not every state has the same requirements. Some, for example, have reciprocity rules in place. It is always a good idea to double-check that you are up to date on all of the requirements for your facility or practice.

Do Not Delay Credentialing

Medical credentialing is typically time-consuming. As a result, it is critical to give it the attention it deserves! In a medical facility, several things can go wrong (scheduling dilemmas, revenue issues, etc.). It is not a good idea to start this process at the last minute because you must always account for roadblocks. It is in your best interest to start the credentialing process at least five months before the doctor’s start date. This should give you plenty of time to ensure that all of the required boxes are checked!

Check that you have all of the necessary information

If you want to drastically reduce the chances of a delay, make sure all information is recorded correctly the first time. Information is frequently misreported, out of date, or omitted entirely. Sections of a person’s work history, for example, are sometimes not recorded. Another example would be not including a doctor’s start date, which would likely cause processing issues. Cases like these will bog down the entire credentialing process, so make sure everything is double-checked before submitting it.

Advantages of Medical Credentialing

Medical providers in the healthcare industry are given opportunities that they would not have otherwise if not for medical credentialing. The number of patients who have insurance is increasing all the time, and if medical practices could be reimbursed more by insurance companies, the quality of care they could provide to each patient would improve dramatically, not to mention these practices could earn more money. Medical credentialing can be time-consuming, but it can greatly benefit your medical practice.

Medical certification ensures quality assurance

Patients will want medical practices to maintain a high quality of care, and medical credentialing will keep these practices’ standards high. To keep costs low, insurance companies will only provide discounts to practices that demonstrate their competence in their respective fields.

Patients’ safety is maintained

Medical credentialing is also beneficial for patient safety because it ensures that all physicians and medical practices have the necessary skill sets to perform whatever procedures are required.

Medical errors are far less likely to occur when experienced staff members work with patients. As a result, patients develop a stronger bond with their doctors.

Reduce Revenue Loss

Medical credentialing not only keeps patients safe, but it also keeps money within medical practices safe. Practices are much less likely to lose revenue due to reimbursements that are denied or delayed as a result of credentialing.

If medical practices allow physicians to provide services before the credentialing process begins, the insurance payer may be able to backdate reimbursements to cover treatments.

Increase the number of patients in your medical practice

Medical practices can now gain access to previously inaccessible patient bases thanks to physician credentialing. This means that medical practices will be able to gain more clients and possibly increase their revenue.

Improve the Reputation of Your Medical Practice

Patients are interested in learning about the practices of healthcare facilities. They will investigate the history of any healthcare facility they intend to visit. Your medical practice’s online reputation will improve if you use medical credentialing services. This means your practice will appear more trustworthy, and as a result, more clients will trust you.

Four Common Issues with Medical Credentialing

Medical credentialing is the process of evaluating a doctor’s qualifications and practice history. This procedure entails an examination of a doctor’s completed education, training, residency, and licenses. It also includes any certifications granted by a board in the doctor’s field of expertise. Before a doctor can practice at a medical facility, their credentials must not only be verified for accuracy but must also be added to the organization’s payers. All certifications, training, licenses, education, and so on must be verified prior to their start date. Medical credentialing is a time-consuming process that is always required. Unfortunately, issues do arise during the credentialing process; however, there are several steps you can take to ensure that this process runs as smoothly as possible.

Incomplete or incorrect applications

This occurs frequently. Before submitting an application, it should be double- and even triple-checked for accuracy. If you want to avoid denials and delays, make sure that your application is error-free and completely filled out. Contact information, employment history, phone numbers, and other pertinent information will be requested on a credentialing application.

Failure to Follow Up

In order for credentialing to be a successful process, an organization must maintain constant contact with its payers. You must stay on top of them to ensure that your applications are processed in a timely manner. Don’t be afraid to contact them to inquire about the status of your applications. Make it a habit to contact them on a regular basis to check on the status of your submissions.

Waiting For the Process to Begin

In the credentialing process, there is no time for procrastination. You must start the train as soon as possible. It can take some time to complete a thorough background check on a doctor, so give your organization at least a couple of months before you have any reservations, just in case there are any issues.

Not Assigning Roles to Your Employees

Because there is so much that goes into the credentialing process, you must have a competent team in place to ensure that it runs smoothly at all times. Organizations frequently fail to assign roles to staff members in order to manage workload. For example, you’ll need people to enter data and ensure its accuracy. If your organization’s responsibilities are not clearly defined, it will lead to errors, which will result in denials and delays.