It’s a common saying that “If something can go wrong, it will.” Unfortunately, this often rings true, particularly in professional settings. In the realm of healthcare, errors in the credentialing or re-credentialing of a provider can have ramifications that extend beyond mere financial concerns.
Credentialing in healthcare involves a rigorous process of confirming a provider’s identity and competence to offer medical services, ensuring that payors are confident in reimbursing for the services rendered. This procedure, while intricate and demanding, is a legal necessity. It ensures that healthcare institutions uphold their promise of delivering top-tier patient care.
Given the vast number of providers in any healthcare system and the increasing demands from payors for accurate credentialing, the task becomes monumental. Medical staff professionals who shoulder the responsibility of this process often find themselves sifting through extensive provider data for weeks or even months.
This is to ensure compliance with accreditation standards and to sidestep expensive errors. Manually collecting data for each provider is a Herculean task, and without technological assistance, overseeing this process becomes an uphill battle.
Financial and brand implications
Discussing the financial implications, the meticulous nature of credentialing means that any lapse can lead to significant costs. Rectifying such mistakes involves not only identifying and correcting the error but also incurring labor costs and fees for the necessary revisions. Such setbacks can lead to delays, potentially causing forfeited reimbursements from payors. These losses can range from hundreds to thousands of dollars on a case-by-case basis.
A study by Merritt Hawkins indicates that an average physician brings in approximately $2.3 million annually for a facility. Thus, any hindrance in the credentialing process can cost an institution an estimated loss of $9,000 per provider each day. The repercussions of poor credentialing can be even graver, leading to patient complications or even fatalities if treatments are postponed or not scheduled. This can culminate in hefty lawsuits due to medical credentialing negligence, tarnishing the financial and reputational standing of the health system.
More than half (54%) of medical practices have reported an increase in denials related to provider credentialing in 2021. This is a significant concern, especially when considering the financial implications for medical practices.
Patient-centric consequences
The essence of credentialing lies in ensuring that providers possess the requisite credentials and clinical expertise. It’s a daunting thought to consider undergoing a surgical procedure by a provider who has only executed it once before. Recognizing which providers are qualified for specific treatments is paramount, as errors in granting privileges can result in patient harm or even fatalities.
Staying updated with evolving industry norms and regulations and creating privilege delineation forms in line with them is a challenging and labor-intensive endeavor. Yet, for the sake of patient safety, clinician contentment, and initiating the revenue cycle, swift and precise credentialing and privileging of providers is indispensable.
In today’s age, with payors emphasizing the importance of quality care, a refined privileging process is non-negotiable for ensuring patient safety and initiating the revenue cycle. By harnessing integration and credentialing technology, healthcare institutions can bridge processes from start to finish, from privilege applications to consumer lookups. This not only saves time and money but also facilitates comprehensive electronic privileging.
Boosting clinician morale
For providers, the processes of credentialing and re-credentialing are cumbersome administrative chores, especially when payors frequently update their requirements. They might find themselves investing hours or even days filling out forms, verifying documents, and responding to queries. This diverts their attention from patient care, leading to potential revenue losses for the healthcare institution and escalating provider exhaustion.
Moreover, for medical staff professionals, a flawed process can result in credentialing errors, dampening morale. These professionals aim for perfection and anticipate their organizations to implement robust processes that adhere to the highest quality benchmarks.
Instituting well-documented policies, procedures, and a quality assurance program that spots errors before they escalate can pave the way for a harmonious environment for all stakeholders, including doctors, staff, patients, and the entire organization.
Nearly half of survey respondents who say they experienced a medical error say that it was reported to medical personnel, other health care facility staff, or to someone else.
Mitigating credentialing errors
While credentialing errors are inevitable, they can be substantially reduced, ensuring smoother transactions with payors and fewer claim denials. By adopting provider credentialing and privileging software, the medical staff services department of a health system can seamlessly manage the entire provider lifecycle.
Automated credentialing technology simplifies data collection, secure access, and reporting. It ensures continuous compliance for providers, credentialing staff, and approval committees. Such advancements have led hospitals to report a 20% decrease in credentialing timelines and a 50% reduction in committee review sessions.
Effective management becomes feasible with the right software, ensuring comprehensive verification of physician credentialing and timely alerts for impending license or certificate expirations. Furthermore, integrating a privileging system with credentialing guarantees that providers are assessed based on their training, experience, and clinical skills, minimizing potential harm to patients and related risks.
Why checking is important
Checking if a doctor or nurse can do their job is super important, especially when payors base their reimbursements on the quality and qualifications of the care provider. It’s like making sure a teacher knows their subject before they teach a class. In the big world of hospitals and clinics, this checking process is like a guard at the door, only letting in the very best doctors and nurses. Especially when the job is very special and tricky, we need to be extra sure.
Nowadays, with computers and the internet, people can even see a doctor without leaving their homes, and payors are increasingly covering telemedicine services, making credentialing even more crucial. This is called telemedicine. Because of this, it’s even more important to make sure doctors from all over the world are really good at their jobs. Everyone, no matter where they are, should feel safe and trust that they’re getting the best care.
So, when we talk about checking doctors and nurses, it’s all about keeping patients safe and happy. It’s about making sure that when someone goes to a hospital or clinic, they know they’re in good hands. And with the help of technology, we can make this happen even better!
Nowadays, with computers and the internet, people can even see a doctor without leaving their homes, and payors are increasingly covering telemedicine services, making credentialing even more crucial. This is called telemedicine. Because of this, it’s even more important to make sure doctors from all over the world are really good at their jobs. Everyone, no matter where they are, should feel safe and trust that they’re getting the best care.
So, when we talk about checking doctors and nurses, it’s all about keeping patients safe and happy. It’s about making sure that when someone goes to a hospital or clinic, they know they’re in good hands. And with the help of technology, we can make this happen even better!
Connect With Our Team of Experts
Payrhealth is a full-service payor-provider relationship manager. We see a future where providers and payors can make more informed decisions together to build a strengthened healthcare system. Learn more through a free consultation with our world-class experts today.
