Credentialing Issues to Avoid in Healthcare

Credentialing Issues to Avoid in Healthcare

Experts at PayrHealth know that healthcare providers are required to regularly update and verify their qualifications. These qualifications can include their physicians’ education, career history, residency, and licenses.

This process of assessment and verification is called medical credentialing, and healthcare providers should understand the importance of credentialing in healthcare. It’s a necessity for all care practitioners in order to provide health services to patients, and it presents a safeguard against malpractice lawsuits and accusations of negligence.

To that end, running a successful healthcare operation means paying close attention to credentialing and keeping an eye out for possible problems down the road. 

Let’s review 4 common credentialing issues and how to overcome them. 

#1 Outdated Contact Information

Outdated contact information may seem like a small issue, but about 85% of credentialing applications have missing or outright wrong information. While some information doesn’t require urgency, misreported or unverified information on specialty licenses, malpractice claims, and disciplinary actions can be detrimental to processing an applicant smoothly and efficiently. 

Failing to credential and verify a provider accurately falls under the category of “negligence,” which can result in a medical malpractice lawsuit if anything happens to a patient as a result of negligence.

#2 Lack of Credentialing Staff

Credentialing is especially difficult when there aren’t enough medical staff members to handle the verification process for each applicant. Healthcare credentialing is extremely laborious and time-consuming, and it requires the utmost accuracy, attention to detail, and patience. Every person who works at a medical facility must undergo credential verification, including (but not limited to)

  • Doctors
  • Nurses
  • Therapists
  • Physicians assistants

Even when there are enough staff members to manage the workload, the extensive amount of documentation can lead to frustration. This is when mistakes become more frequent and lead to future complications.

It’s crucial to check on every applicant’s qualifications and history in order to avoid a potential malpractice or negligence lawsuit. In the eyes of the law, the healthcare facility is just as accountable as the provider if something goes wrong.

#3 State Compliance Differences

Laws governing medical credentialing vary from state-to-state and some states have what’s called a reciprocity rule, meaning healthcare providers can practice from state to reciprocal state without relicensing or having to attend school again. 

For states without a reciprocity rule, it’s important to understand your specific state’s credentialing laws. For example, take a look at the following states’ requirements for chiropractic and naturopathic licensing:

  • In all U.S. states, chiropractors must be an accredited Doctor of Chiropractic (D.C.) and must pass special state exams, NBCE exams, or both.
  • Only 17 states license naturopathic physicians. Licensure generally requires a degree from an accredited 4-year school of naturopathic medicine and passing a postdoctoral board examination.
  • Most states regulate massage therapists by requiring a license, certification, or registration. Standards and basic requirements vary by state, but most states require a minimum of 500 hours of clinicals.2

Each practice varies greatly in the amount of education required, as well as what exams need to be passed (if any). It’s worth noting that certain states are now collaborating with an interstate medical licensure compact,3 which makes medical licenses transferable between participating states.

Each state has unique prerequisites for every sector of the medical field, and being licensed in a reciprocal state does not guarantee a smooth transfer of credits or licenses. Each applicant must be thoroughly vetted in their credentials to avoid errors that result in patient care accidents, negligence lawsuits, and other negative consequences of an unqualified physician.1 

#4 Poor Time Management

The most pervasive problem in the world of medical credentialing is simply poor time management. Many hospitals and other providers jump ahead in the hiring process—first they hire the provider, set their start date, and then they verify credentials and enroll the practitioner.

In reality, the safest and most compliant way to onboard a provider is to verify their credentials first, then hire the person, and finally set a start date and enroll. 

By beginning with the hiring process and verifying the credentials later, you could be:

  • Jeopardizing compliance with Medicare
  • Forfeiting reimbursement money
  • Inconveniencing the provider and patients
  • Taking double the time to complete the steps in provider credentialing

Most applications and credentialing can take anywhere from four weeks to four months to complete. This includes recertification and re-licensure, which can put a serious halt on a practicing provider—and the income brought in by that person. 

How to Overcome Medical Credentialing Issues

From outdated contact information to navigating the nuances of state regulations, medical credentialing can pose quite a few obstacles to any healthcare service. But with a little preparation and strategy, you can avoid and overcome any issue and continue focusing on what you do best—care for patients. 

1. Keep Contact Information and Licensing Current

Completing the credentialing process correctly the first time will save time, resources, and effort in the long-run. 

It may take a little longer to verify the information and finish the credentialing application, but it’ll be well worth the effort. If credentialing is the main source of delay in the process, then you’re less likely to have other delays in the future. 

2. Have an In-House Credentialing Team (or Outsource)

Instead of sharing credentialing duties with whoever happens to have the time, dedicate one team to the task to ensure accountability and excellence. The team would preferably be in-house to streamline the physician credentialing process seamlessly.

However, keeping enough medical staff on-hand isn’t always possible. In this case, hiring an outside team of contractors or using a separate credentialing company to manage the process is the most efficient and effective way to manage such in-depth verification.

3. Pay Special Attention to Individual State Compliance Guidelines

When a healthcare provider transfers from one state to another, a critical part of the credentialing process is to verify that their credentials carry over. Each state has different requirements for different medical fields, so having knowledgeable credentialing staff is crucial to ensuring a smooth and compliant transition. 

Be sure to verify your state’s compliance guidelines for:

  • Licenses
  • Certifications 
  • Education credits

Under appropriate circumstances, it’s worth looking into interstate licensing for providers at a given facility. This is especially helpful if a medical practice or group spans across state lines, since keeping a provider in-network is the easiest way to move around without the hassle of going through the full credentialing process each time.

4. Create a Credentialing System Using Automation and Technology

Incorporating up-to-date technology and using automated systems can help to shoulder the burden of seemingly endless verification and provider data collection. Investing in an automated credentialing process can help your business in a variety of ways, including:

  • Alleviate credentialing workload for your staff
  • Freeing up time and resources for more growth
  • Reducing training time for new credentialing staff members

Taking care of staff members to ensure they have the easiest process available will help them to credential with more precision and less stress. 

Yes, advanced technology like this is usually expensive and takes time to set up, but what you save in money and time yields great return in the long run. A happy staff reduces turnover, which cuts down on cost and time lost, which in turn makes your providers more profitable and your medical business more successful. 

Make the Most Sense with PayrHealth

You know that proper credentialing helps your business run smoothly. But that’s not all your healthcare organization needs to be as efficient and effective as possible.

Since insurance companies require medical providers and facilities to be credentialed before payment occurs, the provider credentialing process goes hand-in-hand with payor contracts. That’s why avoiding delays and streamlining the credentialing process is an integral part of the business as a whole. By removing the headache of credentialing, and subsequently payor contracts, you can return to what you do best: providing your patients with expert services and guidance.

At PayrHealth, we’re the experts in everything concerning payor contracts. For the top service in credentialing best practices and excellent rates, look no further than our managed care contracting solution. 

Take the headache out of payor contracting, and contact PayrHealth today to get started.

Sources: 

  1. Capminds.com. How To Overcome The Challenges In Medical Credentialing? https://www.capminds.com/blog/how-to-overcome-the-challenges-in-medical-credentialing/
  2. NIH.gov. Credentialing, Licensing, and Education. https://www.nccih.nih.gov/health/credentialing-licensing-and-education
  3. The Medical Licensure Group. Which States Have Medical License Reciprocity?  https://medicallicensuregroup.com/medical-license-reciprocity/