Prevent 5 Errors in Healthcare Credentialing Procedures for 2023

The process of healthcare credentialing is demanding and requires a lot of resources and effort. It’s not a one-time thing like exercise; it’s an ongoing requirement in your medical practice that needs constant attention.

 Healthcare credentialing is necessary for healthcare professionals such as doctors, nurses, medical assistants, and therapists. Basically, anyone who works with patients must go through the process of verifying their credentials.

 Some things could be improved in the credentialing procedure. If you don’t avoid them, they can have negative consequences for your business, such as losing income or even facing lawsuits in the worst cases.

Why Is Healthcare Credentialing Necessary?

Credentialing mistakes can cause financial problems like late payments, penalties, and government program cancellations. In rare cases, it can even harm patients and lawsuits for negligence. 

Let’s take an example where a patient could have been saved. There was a surgeon who still needed to complete a one-year residency in lily tomlin plastic surgery and needed board certification. Due to this, the surgeon made a mistake during a procedure, and the patient’s foot had to be amputated, resulting in an $8 million lawsuit. One can avoid this situation if the surgeon has the right credentials.

Credentialing is not just a legal requirement but also benefits your organization, especially if you plan to expand. Patients prefer Primary Healthcare Services in addition to other specialties that their insurance providers accept. This not only builds trust in your practice but also helps in promoting it.

What Pitfalls You Need To Avoid In Healthcare Credentialing?

The healthcare credentialing process can be time-consuming. Contracting usually takes about 60 to 90 days and an additional month. Medicare enrollment takes around 41 days on average. Mistakes in the application, lack of follow-up, or missing paperwork can make the process longer.

In the last decade, we have discovered common mistakes that prevent clients from completing credentialing efficiently. If you decide to handle this task, we recommend avoiding these major pitfalls in the healthcare credentialing process.

Understand The Laws For Every State

Make sure you comprehend the laws and rules in your state. Healthcare credentialing differs in each state, so knowing what your state requires is important. Some states have agreements where credentials from one state are accepted in another, but not all states have this. Knowing beforehand is a good idea to save time when you start the process.

Outsource Credentialing

You surely understand that credentialing takes a lot of time. It’s a boring process with many problems that could save you time and money later. The best method is to get in touch with a trusted company specializing in Medical Credentialing Services. Doing so can help you save every penny you deserve and have more time for patient care.

Gather all the necessary documents.

If the information in the Council of Affordable Quality Healthcare (CAQH) system needs to be more accurate, it will cause a delay in the credentialing process. Studies show that 85% of software has information problems like wrong, missing, or outdated data.

Be careful when collecting data for the first time. It will speed up the process and save valuable time and effort in the long run. You want to avoid unnecessary delays due to providing incorrect data because state healthcare credentialing can take 90 to 150 days.

Every employee who provides patient care in your clinic must go through the procedure. They must give details about their education, work experience, training, qualifications, address, and licenses. Sometimes, certifications like CPR or RBT are also required. It’s essential to know the state standards, the first step mentioned earlier because documentation requirements vary from state to state.

Application Submission

To apply, the first thing you need to do is form a submission. Before that, depending on the clinic or insurer network, you may have to undergo a pre-application process. This procedure involves a background check to ensure that the medical workers are hired to meet the requirements for healthcare credentials. They examine criminal records, punishments, suspensions or expulsions, and board certifications.

Once you complete the pre-application procedure, you can submit all the important information. Submit the error-free application the first time to avoid any delays. The longer the healthcare credentialing process takes, the longer it will take for the treatment or services to be billed.

To help you with the credentialing process, here’s a checklist to ensure a smooth experience:

  • Gather your documents and educational qualifications.
  • Ensure you have your current healthcare license, DEA clearance, and state board certification.
  • Provide information about your professional experience.
  • Have your individual immunization records ready.
  • Keep your personal medical record handy.
  • Prepare both personal and professional references.
  • Explain any gaps in your job history.

Do Not Forget To Follow-Up

It’s essential to follow up quickly after you apply. You need to do this to ensure everything goes with the flow and nothing is missing. Some insurance companies have yet to tell people about application problems, making the process longer.

Understand when things are due & make a schedule

Sadly, it typically takes at least six months for health insurer credentialing. As I mentioned, some insurance companies require credentialing before letting you have payor contracts or reimbursements. Knowing the exact details about when the insurance companies’ policies take effect can help you plan your finances for the future.

Final Thoughts

Mistakes in credentialing can cause financial problems like late payments, penalties, and cancellation from government programs.

To overcome the issues:

  • Understand The Laws For Every State
  • Outsource Credentialing
  • Gather all the necessary documents.
  • Application Submission
  • Do Not Forget To Follow-Up
  • Understand when things are due & make a schedule