To avoid any complications, whether you are adding a new doctor or launching your practice, you must begin the credentialing process as soon as possible. If you disregard the importance of the credentialing process, you will encounter delayed cash flow, problematic scheduling due to patient restrictions, and repetitive phone calls to and from payers.
What Is Provider Credentialing?
Provider credentialing is the process by which medical organizations and Insurance companies verify the credentials of healthcare providers to ensure they have the required licenses, certifications, and skills to properly care for patients. The process is also called physician credentialing, medical credentialing, or doctor credentialing.
Provider Credentialing also entails a background check on the provider’s criminal and financial past, as well as their social media history. References will be checked as well. It’s a time-consuming process that can take longer than expected, so plan ahead of time. Here are some quick tips for a successful provider credentialing process.
Appoint a Credentialing Coordinator
Whether you outsource credentialing chores or handle them in-house, appoint a credentialing coordinator to keep track of deadlines and expirations is a wise business decision. They can send out timely reminders to guarantee that no one’s credentialing expires and that reimbursements are not refused as a result.
Give plenty of time to complete the credentialing process
While credentialing “should” take 90 days and practical procedures allow for 150 days. Credentialing with payers must take place on their timetable, and each has its own. Assume that credentialing will take 150 days, and you’ll be pleasantly pleased if it takes less.
Follow the Coalition for Affordable Quality Healthcare’s Credentialing Program to stay up to date
Payers are increasingly adopted the Coalition for Affordable Quality Healthcare (CAQH) standard credentialing program. Interfacing with this software is valuable because physicians who routinely update and attest their information with the CAQH enjoy more efficient credentialing and re-credentialing experiences.
Link the new provider start date to the submission of credentialing forms
Many practices require credentialing papers as soon as an offer of employment is made. Others associate a new physician’s start date with paperwork submission. For example, you may set a new physician’s start date no later than 120 days after receiving his or her credentialing information.
Establish a Long-Term Credentialing Process
Creating a credentialing workflow can be difficult, but it will benefit you in the long run. Even if you outsource the credentialing process, your workflow should include all needed forms and papers. Re-credentialing appears to be a constant in a multi-physician practice, and a workflow to support it benefits the practice immensely.
Maintain up-to-date contact information for all physicians
Make sure that your office manager or credentialing coordinator has accurate and up-to-date contact information for all physicians. Dealing with credentialing or re-credentialing issues can take longer than it should if there is no direct communication. The credentialing procedure also entails the filing of several forms, and good communication is crucial throughout.
Ensure that all physicians understand what is expected of them
Each provider should be aware of his or her responsibilities in terms of credentialing or re-credentialing. Make it evident to the new hire as soon as the job offer is made that you require specific information, such as work and education history, certification and license information, and malpractice liability certification, among other things.
Perform your background check early on in the process
Before making an employment offer, many practices prefer to do their background check on incoming physicians, including verifying training, licensure, and employment history. It may appear to be overkill, but it can save you from employing a doctor only to have licensure issues later on.
Understand Your State’s Regulations Completely
Your state may have its provider credentialing regulations, as well as reciprocity agreements with payers and other state credentialing bodies. If a physician is credentialed with a payer in another state before transferring to your practice, the payer may simplify credentialing for the new employment.
Understanding how credentialing works can significantly impact how smoothly a practice runs and how quickly income flows. Credentialing issues may be costly and drain productivity, so it’s critical to have a process and a plan in place to ensure credentialing is constantly up to date. Credentialing can become months of back-and-forth phone calls and documentation. It is highly time-consuming. Rather than hiring a company that only provides credentialing services.
Why is credentialing so important?
Medical credentialing is increasingly important because it is the one procedure that allows patients to confidently place their trust in their chosen healthcare providers. RMB credentialing processes offer organizations efficiency, thereby reducing the burden on all stakeholders and positively impacting quality.
What are credentialing services?
Credentialing also means primary source verification which is performed by many credentialing companies across the United States and is the process of validating that a provider meets the standards set forth by the state, employer or the insurance company.
Written by: Kaynat Ishfaq
Author has been writing from last 4 years in Healthcare and medical billing field.
Revenue Cycle Management Consultant, Medical Billing & AR Audit, Free Standing Emergency Rooms, Micro Hospitals, Compliance, OON Negotiations, Digital Marketing
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