Six provider credentialing mistakes and how to avoid them
We all know that healthcare provider credentialing can be time-consuming and complex. As such, there are countless opportunities for errors and omissions that delay the process. The good news is that you can avoid common credentialing mistakes by leveraging technology and promoting streamlined, compliance-driven workflows. What are the most common mistakes credentialing specialists should avoid? Here are six of them.
Mistake #1: Underestimating the true impact of healthcare provider credentialing errors.
Why is credentialing important for healthcare providers? And how do data entry errors affect provider credentialing?
Ultimately, it’s about being able to provide high-quality, timely patient care. If providers aren’t credentialed, they can’t see patients. Not only does this equate to lost revenue opportunities, it also potentially creates patient access challenges and can have a negative effect on the overall patient experience. In addition, delayed credentialing can increase physician dissatisfaction and even lead to costly claim denials, fines, penalties, exclusion from federally funded programs, and malpractice suits.
By creating an efficient provider credentialing process that includes comprehensive and accurate provider data, providers can get to work as quickly as possible. This is important for all providers and especially for new medical practices trying to build their patient base.
Mistake #2: Not starting the provider credentialing process as soon as possible.
The provider credentialing process should begin as soon as new providers sign an employment contract. Worst case scenario is that a provider has a full schedule, but isn’t yet credentialed. When this happens, all of the provider’s patients must be rescheduled, again fueling frustration all around. It’s okay to proactively fill the provider’s schedule, but you need to get the credentialing process going long before that.
Mistake #3: Allowing providers to treat patients before the entire healthcare provider credentialing process is complete.
Though it may be tempting to permit providers to treat patients during the lengthy credentialing process, doing so can expose healthcare organizations to potential fines, penalties, and lawsuits. It all goes back to compliance and risk mitigation. Best practice is to focus on what you can do to streamline the provider credentialing processes and the rest will fall into place.
Mistake #4: Relying on manual workflows, insufficient staff.
Healthcare provider credentialing requires a lot of attention to detail. Health systems must be able to update and verify all certifications and licenses for every provider who administers services to patients. As healthcare mergers and acquisitions continue to occur, not only does the volume of providers requiring credentialing grow, it’s also hard to stay on top of state- and payer-specific requirements. This is especially true during a time of healthcare staffing shortages when important steps in the credentialing process may slip through the cracks as staff become overworked and burned out. In addition, manual workflows slow staff down and create bottlenecks in the overall process.
Between staffing shortages and manual credentialing processes, healthcare organizations run the risk of overlooking deadlines, forgetting to submit critical documentation, and more. In some cases, it may make sense to outsource all or a portion of your credentialing processes. The same is true for revenue cycle management.
It may also make sense to consider credentialing software to help with the overall process. For example, credentialing software can provide insight into every step of the credentialing process, including the ability to follow up with payers and make sure they’re actively processing applications. It can track and trend all stages in the physician credentialing life cycle and can escalate processing issues, when necessary. It can also proactively monitor document expiration, conduct ongoing CAQH re-attestations, and more.
Mistake #5: Not using a provider credentialing checklist.
Provider credentialing checklists can greatly enhance compliance because they help everyone stay organized and promote consistency. If your health system spans multiple states, consider developing state-specific provider credentialing checklists that you update annually as new legislation is passed and other changes occur. Payer-specific provider credentialing checklists can also be helpful. Review each payer’s application closely and develop a checklist based on specific requirements.
Mistake #6: Not using primary source verification.
Healthcare organizations can easily make credentialing errors when they rely on inaccurate or outdated sources of information. Best practice is to use primary source verification (e.g., medical schools, state licensing boards, policy issuers for malpractice insurance) or approved-equivalent sources. Using primary source verification is also a Joint Commission requirement.
Conclusion
Provider credentialing requires time and attention, but it doesn’t need to be an arduous process that drains internal resources. Explore how expert provider credentialing services and technology can help. Learn more at www.edgemed.com/provider-credentialing.
