How Technology Can Simplify the Medical Credentialing Procedure

Verifying the credentials and expertise of healthcare practitioners is a crucial step known as physician credentialing. It's a careful examination of the training, credentials, experience, and education of a healthcare practitioner to ensure they can provide the best possible services to patients. It's an important step for medical providers and health insurance companies alike. Physician credentialing, however, can be expensive, time-consuming, and complicated. The use of technology in expediting the medical credentialing process has grown in the last several years and will continue to grow. Here are a few ways healthcare credentialing can be made easier and more efficient with technology - and the help of a knowledgeable healthcare industry expert.

How Medical Credentialing Works

Before discussing how technology might expedite the medical credentialing procedure, let's review the process itself. The extensive provider credentialing process includes verifying healthcare practitioners' credentials, history, and experience. Typically, the procedure includes the following steps:

Application

You receive an application from the credentialing body. You complete this application with information about your board certifications, healthcare facility, licensing boards, malpractice claims, medical license, peer references, and any supporting documents. Doing this in a timely manner ensures the rest of the process moves along more quickly.

Primary Source Verification

The main source of each credential is contacted by the credentialing body to confirm the healthcare provider's credentials. The company will, for instance, contact medical schools to confirm credentials, state medical boards to confirm licensing, and prior employers to confirm employment history.

Background Investigations

Healthcare professionals are subjected to background investigations by the credentialing organization, which may involve a review of their criminal and malpractice histories and any fines imposed by medical boards or other regulatory bodies.

Committee Evaluation

A committee of medical experts examines the qualifications of the healthcare practitioner to see whether they satisfy the minimal requirements needed to practice medicine safely and efficiently as an in-network provider.

Decision

Whether or not to provide the healthcare professional with a certificate is up to the certifying body. The healthcare professional may file an appeal if they are not accredited.

Technology's Role in Simplifying the Medical Credentialing Procedure

The healthcare provider credentialing process may be expensive and labor-intensive, and it may take months to finish. Nonetheless, the use of technology has only benefited healthcare credentialing. Here are a few ways.

Electronic Applications

Electronic applications are one way technology has simplified the medical credentialing procedure. With the ability to electronically submit credentials, healthcare practitioners can save time and minimize mistakes. Healthcare professionals can get their credentials more rapidly by using electronic applications, which can also be processed more swiftly.

Automated Validation of Primary Sources

Another way technology has made healthcare credentialing easier is by automating source verification. By gaining access to databases of primary sources, including state medical boards and medical schools, credentialing organizations automatically validate healthcare providers' qualifications. Manual verification, which may be laborious and prone to errors, is no longer necessary.

Artificial Intelligence (AI)

Another technological advancement used to expedite the medical credentialing process is artificial intelligence (AI). AI algorithms can analyze large data sets to find trends and abnormalities pointing to possible problems with a healthcare provider's credentials. AI systems, for instance, can examine past malpractice cases to find behavioral trends pointing to a greater likelihood of malpractice.

Digital Credentialing

Another important technological advancement is digital credentialing. Creating digital credentials that are readily shared and validated online, such as digital badges or certificates, is known as digital credentialing. Digital credentials are more efficient, safe, and readily verifiable than conventional paper credentials.

Cloud-Based Credentialing Software

Cloud-based credentialing software is another technology that speeds up the medical credentialing process. With cloud-based software, such as the National Practitioner Data Bank, credentialing groups can handle the whole process online, from applying for credentials to having a team look them over and decide. This removes the need for human data input and paper-based record-keeping, which can be time-consuming and prone to mistakes.

Telemedicine

Telemedicine is the practice of providing medical treatment remotely by using technology, such as video conferencing. To enable healthcare practitioners to practice across state boundaries without going through the time-consuming and costly process of getting licenses in each state, there has been a growing need to expedite the medical credentialing process with the development of telemedicine. Interstate medical licensing compacts are one method that telemedicine is expediting the credentialing process. With the help of these compacts, healthcare professionals can apply for a license to practice in many states simultaneously. Interstate Medical Licensure Compact, Psychology Interjurisdictional Compact, and Nurse Licensure Compact are three compacts in effect as of 2021. Remote credentialing is another method. This entails gathering and validating data on healthcare providers, including their credentials, education, and training, via technology. Remote credentialing may expedite the credentialing process and lessen the necessity for in-person meetings. Patients may also benefit from telemedicine, especially those who live in isolated or rural locations where access to medical treatment may be limited. Long-distance patients who struggle with mobility or chronic illnesses may find telemedicine helpful since it eliminates their need to travel. However, there are drawbacks to credentialing and telemedicine as well. Ensuring healthcare professionals are authorized to practice in the states where they are offering treatment is one of the biggest difficulties. Additionally, it's important to ensure that telemedicine services are provided privately and securely by all applicable laws and regulations, including HIPAA.

Integration with Provider Directories

Integrating technology with provider directories has also expedited the medical credentialing process. Patients may use provider and internet directories to look for healthcare providers in their area or who meet certain needs. To make it easier for consumers to discover credentialed healthcare providers and fulfill the minimal requirements of competence needed to practice medicine safely and efficiently, credentialing organizations can now connect their credentialing records with provider directories.

The Benefits of Using Technology to Simplify Medical Credentialing

There are several advantages of using technology to expedite the medical credentialing process, such as:

Faster Credentialing

Healthcare practitioners may get their credentials more rapidly thanks to technology, which enables speedier processing of credentialing applications. According to a 2017 poll by the Council of Affordable Quality Healthcare (CAQH), healthcare organizations claimed that employing electronic techniques allowed them to finish the credentialing process 33% quicker than traditional methods.

Reduced Errors

When you enter and check data by hand, mistakes can happen. But with electronic applications and automatic source checking, those mistakes are less likely to happen. The Journal of the AMIA (American Medical Informatics Association) released research in 2018 that indicated computerized verification of medical licenses had a 99.8 percent accuracy rate, while manual verification had a 93.66 percent accuracy rate.

Cost Savings

For many healthcare organizations, using technology to streamline credentialing may save a lot of money. According to the same CAQH study, healthcare companies that used computerized credentialing procedures reported an average annual savings of $1,200 for each healthcare practitioner. This means substantial cost savings for healthcare organizations that accredit hundreds or thousands of healthcare providers annually.

Improved Patient Care

By guaranteeing that medical professionals fulfill the minimal qualifications needed to practice medicine safely and efficiently, technology-enhanced credentialing processes may enhance the treatment of patients. Patients who received care from healthcare providers who were credentialed using electronic methods were more likely to receive recommended preventive care services than those who were credentialed using manual methods, according to a 2016 study published in the Journal of the American Medical Association. This is likely because speeding up the process allows practitioners to focus on patient care without interruptions in their practice.

Increased Protection

Cloud-based credentialing software and digital credentialing provide improved security for credentialing data, lowering the possibility of data breaches. Verified is a cloud-based credentialing technology developed by the Council for Affordable Quality Healthcare (CAQH) that offers improved security features. Verified protects data using cutting-edge encryption techniques and ensures only authorized people can access credentialing data by offering audit trails and access limits.

The Downsides of Using Technology to Simplify Medical Credentialing

Although there are several advantages to using technology to expedite the medical credentialing process, there are also some drawbacks to take into account, such as:

Connecting to Older Systems

Integrating new technologies with existing systems is one of the difficulties in medical credentialing. Older systems are often outdated and may not work with more recent innovations. This may make it difficult for healthcare companies to integrate new technology, leading to higher expenses and longer implementation times. For instance, research published in the American Association of Medical Informatics journal discovered that a major obstacle to implementing electronic health records, or EHRs, in hospitals, was the absence of interoperability between the systems already in place.

Data Privacy Issues

Data privacy issues provide another difficulty when using technology for medical credentialing. Technology is used in credentialing to gather and store sensitive data, such as criminal and malpractice histories. This data has to be kept safe and shielded from unwanted access. According to research published in the Journal of Medical Internet Research, healthcare professionals are most concerned about the security and privacy of their personal information when utilizing online credentialing systems.

Cost of Implementation

Healthcare technology adoption may be expensive. To achieve effective deployment, healthcare companies may need to invest in new software, hardware, and training. For instance, the Office of the National Coordinator of Health Information Technology reported that the price per provider to adopt an EHR varied from $15,000 to $70,000.

Regular Updates and Maintenance

Constant upkeep and upgrades are necessary for technology and may be expensive and time-consuming. Healthcare institutions must ensure their systems are secure and current. System malfunctions and patient data breaches can occur, if not. The cost of these events can be astronomical for any healthcare facility.

Data Errors

Errors and imprecise data are among the dangers connected to automated credentialing systems. Automated systems depend on input data from several sources, and erroneous or insufficient data might cause mistakes throughout the credentialing process. For example, research published in the Medical Internet Research Journal discovered that, in some cases, manual methods may be more accurate than automated systems when certifying healthcare practitioners.

Lack of Standardization

In some areas, the healthcare sector lacks standards, which might make it difficult to deploy a universal technological credentialing solution. The procedures and standards for certifying healthcare workers may vary between healthcare institutions. Consequently, customized technological solutions may be required, which might increase implementation costs and time. For instance, the implementation of EHRs in healthcare organizations has been significantly hampered by the lack of standardization, according to a paper released by the Health Care Information and Management Systems Society.

Resistance to Change

Adopting and deploying new technology may face challenges due to the reluctance of healthcare practitioners. Delays in implementation and lower acceptance rates may arise from this. For instance, research published in the Medical Internet Research journal discovered that worries regarding the precision and dependability of the systems may make medical practitioners reluctant to use online credentialing platforms. Ensuring adherence to legal and regulatory obligations is crucial when implementing technology in credentialing. Navigating through this may be difficult and time-consuming. An illustration of this is the Health Insurance Portability & Accountability Act (HIPAA), which has security requirements for patient data. In medical credentialing technology solutions, compliance with these standards is mandatory.

Healthcare Provider Credentialing with PayrHealth

For healthcare practitioners to practice medicine safely and efficiently, they must achieve the minimal requirements of competence, which is ensured by the medical credentialing process. Technology has many advantages to expediting medical credentialing, such as increased security, lower processing times, fewer mistakes, and financial savings. Partnering with a healthcare industry expert is the best way to ensure a fast, accurate credentialing process. To learn more about how PayrHealth can help your medical practice or healthcare organization thrive, contact us today through our online form.