Avoiding Common Mistakes in Provider Credentialing

In the dynamic world of healthcare, maintaining efficiency and compliance is paramount. One critical aspect of this is credentialing—the process of verifying the qualifications of healthcare providers to ensure they meet the necessary standards. However, the credentialing process can have potential errors and delays. From incomplete documentation to missing crucial deadlines, these mistakes can have serious repercussions on a practice’s efficiency and revenue. Let’s dive into the most common credentialing mistakes and how to avoid them.

Introduction

One of the most critical processes in setting up your healthcare practice is provider credentialing. It ensures that providers meet demanded standards to achieve quality care delivery, so it has a lot of potential pitfalls that can delay or derail the whole process. In this blog, we take a closer look at the pitfalls and offer practical strategies for avoiding them so that your practice enjoys smooth operations and a consistent flow of revenue.

Importance of Thorough Documentation

One of the most common mistakes in credentialing is incomplete documentation. Documentation is necessary since this is the cornerstone in credentialing and establishes qualification and legitimacy of healthcare professionals.
Complete and precise documentation would mean that credentialing bodies can verify a provider’s credentials without undue delay. Missing documents can result in long processing times, which would further delay the provider’s time to see patients and be able to generate revenue.

Commonly Overlooked Documents related to Credentialing Application
There are many documents that can fall through the cracks during the credentialing process. Some common ones include:

Current CV or resume

Professional liability insurance license

Medical licenses

Educational certificates, diplomas

Board certification documents

The only way to avoid these errors is to have a complete checklist that matches each provider and to cross-check all submitted documents against this list. Contact us for the comprehensive document checklist.

Missed Deadlines

There could be many deadlines when it comes to credentialing—deadlines for the first applications, periodic renewals, etc. Missed deadlines could result in a huge loss of revenue to your health care practice.
The failure to meet credentialing deadlines will result in loss of revenue and potential gaps in patient care, thereby affecting patient satisfaction and trust.
To avoid missing deadlines, implement a robust tracking system. Use a digital calendar with important date alert systems and preferably invest in credentialing software because it will automate alerts for reminders as well as manage all the deadlines of credentialing. Appoint a key person looking at the timelines for credentialing who can be ensured that everything reaches the deadline. Additionally, outsourcing credentialing services can be a smart move, as specialized companies have the expertise and resources to manage this process efficiently, ensuring that all deadlines are met without burdening your internal staff.

Submitting Inaccurate Information

While filling a credentialing application, there can be errors related to spelling mistakes, old addresses, and even feeding the wrong licensing information.
What may seem like a small inaccuracy might carry huge implications for a credentialing process, thereby causing a large delay or even a complete denial of the process. Credentialing bodies depend upon precise information in verifying a provider’s credentials, and disparities can cause a need for extra verification steps, further slowing down the procedure.

Common Areas Where Errors Often Occur

Provider names and contact information

Employment history and timelines

Licensing numbers and expiration dates

Education and training details

To avoid this problem, adopt a diligent review process. Multiple staff should have double-checked the information to be submitted and providers should always be part of the process of verifying their details. Outsourcing credentialing services can further reduce the risk of errors, as these companies specialize in managing and verifying credentialing information accurately. Their expertise and attention to detail ensure that your applications are error-free, streamlining the credentialing process and minimizing delays.

Failure to Follow Up

Credentialing does not end at set it and forget it. Active follow-up is critical for ensuring that applications are on the go and are, where possible, clearing any obstacles that might crop up along the way.
Any issue can be detected early and resolved, so it keeps any delay from happening throughout the process. It also portrays to credentialing bodies that the practice is proactive and organized, which might accelerate the process of approval.

How to Follow Up Effectively with Credentialing Bodies

Develop a routine follow-up process and do so at appropriate intervals. Maintain good records of all contact which enumerates dates and names to ensure follow-through and accountability. Monitor the status of all applications for credentialing and submitted follow-ups by the use of a database that is centralized.

Realistic Time Frames for Credentialing

Credentialing is quite a timely affair and may last for several months. Missing the required time may lead to rushing applications, which could result into higher chances of more errors.
Realistically, credentialing can take place from between 60 to 180 days, depending on the level of background on the provider and the effectiveness of the credentialing body. This is a factor in planning that should be put into consideration when thinking about new provider orientation.

Issues that can further slow the credentialing process:

Inaccurate or incomplete documentation

Slow response of previous employers or educational institutions

Credentialing organizations have high volumes to work through

Planning Well in Advance for Unforeseen Circumstances

Beginning the process of credentialing well in advance of the provider’s expected start date takes all of the previously discussed causes for delays into consideration. Build in a bit of a cushion for unforeseen issues, and continue to communicate with everyone throughout

Conclusion

Staying away from common provider credentialing errors is necessary for the financial viability of a health care practice and also to achieve operational excellence. The ways to eliminate the clogs in the process to ensure a delay time related to processing can be avoided are getting hold of complete documentation, meeting the deadlines and submitting accurate info, thorough follow up, and scheduling enough processing time. These implementation strategies will not only enhance the credentialing experience but also provide improvement overall to the efficiency of your practice.
Take your credentialing process to another level and obtain professional help with RevGroMD experts. We’ll work diligently to ensure you are credentialed promptly and accurately so you can get on with business and do what you do best: taking good care of your patients.

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