Medical credentialing is a time-exhausting process. In fact, not only is it slow, but it can also be extremely convoluted and confusing, especially if you have limited experience. What’s worse, you’ll lose more and more money with each passing day a practitioner’s credentials aren’t verified.
Because of that, medical providers are always on the lookout for new solutions that would help them expedite the process. For example, in the last few years, hospitals and clinics have found lots of success with AI-driven software. Another great practice is to delegate credentialing to external providers who have much more expertise and can focus on this activity.
There are several reasons why expert credentialing is so incredible. First and foremost, it allows your medical and administrative teams to focus on patients and to provide them with the best healthcare possible. By hiring external companies, you can also eliminate errors that commonly appear when you’re verifying credentials in a rush.
In this article, we’ll explain credentialing, how it can save time, and what other benefits it can yield for your medical business.
What is credential verification?
Medical credentialing, also referred to as credential verification or physical credentialing, is a process during which a practitioner is fully onboarded. The process is crucial for everyone involved, from medical organizations to regulatory boards, patients, and insurance companies.
During this procedure, a medical company will check future employees’ degrees, certifications, education, incoming lawsuits, and bans, as well as work history. That way, they can ascertain whether a person is suitable for the position they applied to. Not only that but credentialing also instills trust in patients and peers.
Credential verification is also crucial for insurance businesses, otherwise referred to as payers. Whenever your hospital or clinic treats a patient, they need to showcase that the procedure was done by a certified professional. Otherwise, a medical company can’t get reimbursement for the provided service.
Of course, having lots of verified professionals in the country is vital for the overall healthcare system. Heavy regulation ensures that all citizens get the best medical assistance possible while also reducing the number of medical errors.
What is re-credentialing?
The annoying thing about credentialing is that this is something you need to do every so often. Even if a person has been in the business for a long time, you must complete this procedure once every two years. This is especially important because of potential malpractice suits and other bans that would prevent a practitioner from doing their job.
Unfortunately, although there’s a good reason why regulatory bodies demand re-credentialing, this procedure puts a lot of burden on medical providers. In other words, even if you haven’t employed new staff members in the last few years, you’re forced to perform this activity all the time. In fact, this is why even small clinics hire external onboarding providers.
How do external providers save time?
Credentialing is an extremely time-sensitive activity. The process takes from 60 to 120 days, sometimes even longer. During that time, a practitioner can get any reimbursements from payers, which is why most of them won’t even provide service. Someone else will take on their job while they sit at home.
The worst thing about this is that credentialing starts after signing a contract. In other words, whether a practitioner is in the office or not, you’re still obliged to cover the wages. This, in itself, is a good reason for expediting the process.
As mentioned, fast credentialing is vital for brands that have a high employee turnover. The process is especially crucial for deficitiary specialists, as many companies don’t have enough employees to tackle all the workload. Ultimately, through quick onboarding, clinics and hospitals can provide better service, thus increasing user satisfaction.
4 Reasons for delegating credentialing
Naturally, the main reason why we outsource credentials verification is so we can save time and money. However, things are a bit more complex than that; here are the four main reasons why you should hire external providers:
1. Limited resources
Some healthcare providers simply don’t have the resources to perform credentialing on a constant basis. This is especially true of small to medium clinics that are already swamped with work. Instead of treating their patients, they need to tackle the annoying task of credentialing, often during their spare time.
2. Limited expertise
Due to its complexity, the credentialing process requires some know-how. Your employees should be well aware of the local and federal requirements and follow the latest trends. To make matters worse, they need to know how to maximize credentialing software. Otherwise, you’ll spend a lot of time learning about the optimal procedures, which can feel awful during the first few years.
3. Regulatory changes
As mentioned, the regulatory framework can be significantly different from state to state. While the US has a somewhat unified system, there will always be gaps between local regulations. Because of that, credentialing is also tricky for professionals who have recently moved to another city.
The worst thing about all of this is that you’re legally obliged to provide proper verification. Any blunder you might make, intentional or otherwise, can come back to haunt you. In some situations, you might incur massive fines, making outsourcing an excellent preventative measure.
4. Reduced scalability
As a small company, you might get away without partnering with external providers. However, as your business grows and you acquire additional clinics and hire extra help, the process becomes that much harder. Not only will you be forced to verify the credentials of all these incoming employees, but you’ll also have to tackle much more credentialing.
Building an in-house team is usually the best solution to this problem. Unfortunately, as you’ll likely want to focus on your primary operations, your employees might get sloppy training. Furthermore, you won’t have as much time to control this department. Hiring a reliable provider can circumvent all of these and eliminate some of the micromanagement.