In the intricate world of healthcare, provider credentialing stands as a pillar often hidden in plain sight. It’s a frequently overlooked process, yet pivotal to not only physicians and other medical providers being able to practice medicine, but also to ensuring patient safety. Properly maintaining provider credentials is notoriously complex and time-consuming. The consequences of not having a solid process in place can cause errors, lengthy delays, loss of revenue for providers and medical practices, and gaps in providers being able to practice; patient care is also ultimately affected. Because provider credentialing is so highly specialized, it can benefit a medical practice to outsource the process to a credentialing expert.
How can you ensure you have the right credentialing team in place? Here are four essential steps tailored for medical practices.
Make sure your candidate understands the job
Keeping the provider ready to see patients is key to the functioning of any medical practice. Obtaining and maintaining a valid license is a necessary first step followed by credentialing and payer enrollment. While credentialing, provider licensing, and verification may seem straightforward, without a streamlined process and experienced credentialing team at the lead, it can be painstakingly slow and filled with hurdles. The intricate task of credentialing also carries a weighty responsibility, often accompanied by tight deadlines and elevated stress. This pressure can lead to burnout and high turnover rates in the field. The demand for adept credentialing professionals consistently surpasses the available supply.
A proactive candidate with a keen interest in credentialing and a commitment to understanding its intricacies can revolutionize a medical practice, laying a robust groundwork for streamlined and efficient credentialing processes.
The art of collaboration with providers
A big challenge for any credentialing team member will be navigating their relationship with the providers they are working with. Physicians are busy, they are serving patients, they are often in highly stressful situations. Understanding how to tactfully and efficiently manage this dynamic will be crucial to successful credentialing.
A few pro tips: Understand there is a delicate balance — providers will often be very slow to respond to emails, and/or they won’t send the documents needed. The right practice manager will be patient and understanding of what that provider’s day actually looks like. Being extremely organized and detail oriented and planning in advance will make sure the information is received on time. Clear, proactive, and concise communication is also crucial. You may only have two minutes with that provider once you finally manage to get them on the phone, so make that two minutes count. Patience and perseverance are skills that are important to remember for a successful team.
Tap into credentialing resources
Healthcare is a heavily regulated industry, and credentialing staff need to stay up to date on the ever-changing regulations from various accreditation bodies, government agencies, and industry standards. A few great resources credentialing staff can tap into include the National Association Medical Staff Services (NAMSS) whose mission is to work with people in the medical staffing and credentialing services field through education and advocacy. The Centers for Medicare & Medicaid Services (CMS) also has a wealth of useful information for credentialing teams, including updates on regulations, guidelines, legislation, and policies. Sending employees to conferences, such as the Medical Group Management Association (MGMA) annual meeting is also beneficial, as is joining state and regional chapters for credentialing organizations.
A modernized credentialing software can also offer major benefits for teams, as opposed to a manual process that often relies on Excel spreadsheets and sticky notes. With software, credentialing teams can easily and seamlessly track payer enrollments as well as receive updates for verifications, as information is pulled in directly from licensing websites. Software can also ensure all of the information is stored and up-to-date and can be easily shared. Transitioning from manual spreadsheets not only saves time, but also ensures documentation is correct and not tampered with.
Patient safety takes precedence
The world of credentialing can be complex and multifaceted, but the right person will understand the importance of their job — to ensure patients are seeing the highest caliber of providers and to make sure that these doctors are who they say they are. Credentialing teams are ensuring that providers are licensed and went to medical school and that whichever patient goes and sees them is in good hands.
Credentialing is often a behind-the-scenes process, and the work of credentialing staff might not be as recognized or celebrated as other roles in healthcare. However, at the end of the day, patient safety takes precedence — credentialing specialists are the gatekeepers to ensure patients are in safe hands.