From large health practices to small private systems, it is necessary for all healthcare organizations to navigate the continuously evolving regulations and requirements surrounding payer enrolment, privileging, and physician credentialing services. For running a profitable medical practice and delivering the best quality healthcare to the patient, it is necessary to perform these functions. Although, physician credentialing services tend to be a tedious, time-consuming, and complex process, particularly when manually handled.
For the previous three decades, the credentialing standard has been Microsoft Excel. Document acquisitions, applications of payer enrolment, and verifications are done by hand. Then a spreadsheet is used for tracking all progress and Outlook’s calendar alerts are used for setting re-credentialing deadlines.
While some practices use this orthodox method for maintaining a proficient system, some primary and independent care practices find it difficult because of their inadequate administrative resources. Several situations can create a credentialing crisis, including:
- In case, the credentialing expert who has been working for a long time decides to leave. Now, there will be no experience staff present to tackle the complicated physician credentialing services, which can result in cash flow problems, non-compliance risks, and delays.
- The organizations with a vigorous growth strategy might realize they are lacking the necessary resources required for supporting a large number of practitioners’ credentialing.
- In-experienced practitioners who have no credentialing experience.
To counter such a crisis, the following are four tips a medical facility can use to safeguard and streamline the credentialing procedure. These tips also permit practices to keep in touch with their current needs of physician credentialing services and raise their future growth capacity.
1. Use Technology to Relieve Administrative Burden
Typically, a big hospital has enough resources to hire a complete administrative department. However, independent and small practices might rely on a single administrator or a small group for piecing together the whole credentialing puzzle.
Several other duties must be handled by the practice administrator, including back-end duties such as billing and human resources and office management at the front-end. Even if a facility has a highly efficient administrator, it is almost impossible to do all of those tasks in a single day.
When automatic credentialing software replaces email alerts and spreadsheets, it becomes easier for administrators to quickly complete all credentialing steps and then focus back on critical tasks. In case the practice administrator decides to quit that medical practice, the training of a new administrator is made easier by the automated credentialing system.
2. Use an Integrated System for Organizing All Documents
A major challenge faced by all healthcare facilities is monitoring the essential paperwork of each physician’s credentialing services. Typically, a physician must collect 500 data points for completing the credentialing procedure, including residency completion, work history, continuing education, board certifications, and licensure.
In case such documentation is absent, it can hinder the practice from proceeding forwards with the payer enrolment. It might also make semi-annual and annual audits prone to risk.
Hence, practices must have a centralized system for storing and keeping track of all required reference links and documentation. Credentialing software alleviates the extra burden of paperwork organization by getting rid of the majority of the hard copies. It instead creates electronic files that are securely stored, easily accessible, and automatically filed.
Any item that is expiring soon or missing can be quickly pinpointed by the administrator. Such paperwork organization also makes sure that accrediting bodies’ audits are successful and painless, as it becomes easier to directly access and inspect any document, rather than going through hundreds of hard copies.
3. Automatic Payer Enrolment for Saving Time
Often, the applications of insurance payers take the longest time in the credentialing procedure and cause immense frustration. In America, around 5,000 payers are operating, and the requirement of each payer changes every year.
After the submission of an application, the processing period might take 4-7 months and also require another follow-up. Therefore, applications must be quickly submitted with complete accuracy. In case of missing information, the application could be rejected causing additional delays.
Also, it is important to select such software that permits a universal populace of the enrolment forms. Such software can quickly and accurately fill and submit multiple applications for various practitioners. After the submission of applications, the system can track their statuses, which removes the requirement for lengthy follow-up calls.
Automating applications of payer enrolment provide faster submission of applications that can make the practices grow. The faster practitioners get enrolled, the sooner it is possible for them to get patient visits and receive reimbursement for the services.
4. Opt Outsourcing to a Reliable Specialist
Primary, independent, and small care practices might gain an advantage from outsources all of their credentialing duties to a skilled third party. Finding a credentialing partner can prove to be cheaper as compared to hiring an office team. This way a medical practice can achieve a greater amount of resources.
Whether you run a new medical practice that has had no credentialing experience before or you own a growing medical facility that requires the capability to enlarge or a developed organization simply seeking to ace the procedure, you can achieve immense help from credentialing technology to accurately and quickly doing the job. It can also save you from any possible credentialing disaster and ensure that your medical practice succeeds in the longer run.
Meta Title: 4 Helpful Tips That Can Save You from a Credentialing Crisis
Meta Description: The latest technology has revolutionized the physicians credentialing services in the medical world. But, it is not easy for small and independent medical practices with limited resources to afford such a system. That is why they are more prone to credentialing crises. Here are four tips regarding how you can save your medical practice from a credentialing crisis.