Credentialing Services

How Practices Can Achieve RCM Success and Increase Revenue with Provider Credentialing

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Provider credentialing applications can be extensive, often causing providers to feel overwhelmed by the vast amount of information they must supply on a quarterly basis. The accuracy of responses on these applications holds immense importance as they determine whether a provider gains or maintains credentials - and determines how soon they can treat patients. Causing delays with provider credentialing can impact your financial stability, cash flow, and ultimately patient experience at a time when the healthcare industry is already facing unprecedented financial pressure. Gathering information from various sources and ensuring that responses are both accurate and comprehensive can be quite a challenge. In this article, we'll give our best tips on the credentialing process, as well as discuss how provider credentialing can take away from your practice's financial health and how PayrHealth can help you uphold patient satisfaction with more efficient processes.

1. License Status and Expiration

In this section, you'll need precise and current information about your professional license status and its expiration date. Key details to include are:

  • The name of your license or certification, such as a medical license, nursing license, or pharmacy license.
  • The state or jurisdiction where your license was issued.
  • The issuance date of the license and its expiration date.
  • Any past disciplinary actions taken against your license or certification.

Honesty and transparency are key here, as providing false, mistaken, or misleading information can have severe consequences to your practice's revenue and financial success - and even more severe consequences including license revocation and legal repercussions. If you have any uncertainty about your license status or expiration date, contact your licensing board or regulatory agency.

2. Educational Background and Specialized Training

When filling in your educational background, begin with your highest degree attained. Begin with details including degree type (e.g. Bachelor of Science, Master of Arts), field of study, institution name, and graduation date. Subsequently, list any additional degrees earned in chronological order, following the same format. If you have any specialized training or certifications relevant to your industry, include these as well. Include the certification or training program's name, issuing organization, and completion date.

3. Work Experience and Employment History

To provide a clear and organized response:

  • Begin with your most recent employment position and work backward.
  • Include details such as the employer's name, location, job title, and a concise description of your responsibilities.
  • Mention the start and end dates of your employment for each position and indicate if you are presently employed at a particular organization.
  • If gaps exist in your employment history, be prepared to explain the reasons behind them.

4. Disciplinary Action by Regulatory or Licensing Boards

If you have never faced disciplinary action, a simple "no" is your response, and you can proceed to the next question. However, if you have encountered disciplinary action from a regulatory or licensing board, honesty and full disclosure are essential. Provide a detailed account of the incident that led to disciplinary action, including steps taken for rectification and prevention of future occurrences. This openness about past disciplinary actions showcases your commitment to ethical and professional conduct. Include any relevant documentation related to the disciplinary action, such as official rulings or records of remedial actions.

5. Malpractice Claims or Lawsuits

Honesty prevails as the best policy when addressing past malpractice claims or lawsuits. It's better to openly discuss any past issues rather than concealing them. Explain the circumstances of the incident and the outcome of the malpractice claim or lawsuit succinctly, sticking to the facts. If you have experienced malpractice claims or lawsuits, explain how these experiences have positively influenced your practice and caused your team to assess performance. Emphasize successful defenses, if applicable, showcasing your healthcare proficiency. If you need help with how to respond or navigate the credentialing process, consider seeking legal counsel. A healthcare industry attorney can offer guidance and support during this process.

6. Affiliation with Healthcare Organizations or Hospitals

If you're affiliated with other healthcare organizations or hospitals, provide complete information about the nature of your affiliation, your role, and the affiliation dates. Be prepared to explain any gaps in your affiliation history, such as breaks for personal reasons or additional training. If you took time off from practicing medicine to care for a family member or pursued further training, be ready to provide supporting documentation.

7. Scope of Practice and Limitations

Describe the patient types or conditions you specialize in treating, along with specific services or procedures you offer. Disclose any limitations or constraints affecting your practice, such as restrictions on prescribing certain medications, performing specific procedures, staffing shortages, or treating particular patient categories. If feasible, support your answers with relevant documentation, such as copies of your license or certifications or letters from colleagues or supervisors vouching for your qualifications and expertise.

8. Professional Liability Insurance Coverage

When addressing your current professional liability insurance coverage, supply policy details, including the insurance company, policy number, and expiration date. Familiarize yourself with specific insurance prerequisites for the credentialing process, as these requirements can differ by state or organization.

9. References

Before starting the credentialing process, make sure to compile a list of references. This gives you the time to carefully choose people who can speak highly of your professional abilities and are familiar with your work. Select references that offer concrete instances of your work, particularly those who work with you in clinical contexts. Always seek permission from individuals before listing them as references to ensure their willingness to vouch for your qualifications. When providing references, include their full names, titles, and contact information. Communicate the areas you want them to address, such as your clinical skills, communication style, or work ethic. After submitting your reference list, follow up to confirm whether they were contacted.

How Provider Credentialing Can Impact Your Revenue Cycle Management (RCM) Success

Provider credentialing is an undertaking for even the most proactive providers. Although credentialing plays an important role, it can be time-consuming when patients need valuable care. Thus, in many ways, provider credentialing can negatively impact your financial performance. At PayrHealth, we can take over your provider credentialing process to prevent revenue loss and accelerate cash flow. With the delicate and complicated nature of the healthcare industry, getting professional help is the key to RCM success. Our team can help optimize your financial health by taking on administrative burdens and relieve unprecedented financial pressure from your revenue cycle teams. With a more efficient RCM process, you can enjoy reduced costs and focus more on what matters - helping patients.

Revenue Cycle Management with PayrHealth

As a best-in-class revenue cycle management firm, PayrHealth provides full-service medical billing and provider credentialing. Experienced professionals with expertise in primary source verification, provider enrollment, and other credentialing-related areas make up our credentialing team. Healthcare organizations that struggle with the intricate and time-consuming process of credentialing, as well as new providers who require assistance throughout the credentialing process, find great value in our credentialing services. For more information on our provider credentialing and enrollment services, contact us online to get started.

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