In healthcare, there is no room for error. Every medical center is expected to maintain high standards for the accuracy and timeliness of information.
This includes conducting medical credentialing, which is a complex quality assurance step to verify details about providers and the facility. In this article, we’ll share 5 medical credentialing mistakes to avoid, plus numerous tips for handling credentialing smoothly.
What is Medical Credentialing?
During medical credentialing, numerous details are checked and confirmed, including licenses, background information, training, educational qualifications, insurance details, compliance factors, and more. This step ensures your facility and staff members remain fully qualified to care for patients. Although patients aren’t directly aware of how the credentialing process works, they rely on it to provide the high level of care they expect.
Proper healthcare credentialing also prevents regulatory problems, insurance conflicts, expensive liabilities, medical errors, and malpractice lawsuits. Handling credentialing smoothly is part of securing valuable reimbursements and running a successful healthcare practice.
Mistake #1 Procrastinating on Medical Credentialing
Never procrastinate on credentialing or your healthcare organization could regret it later when the process backs up and becomes unmanageable and unprofitable. Credentialing should start with gathering all necessary documents into a centralized organizational center, then credentialing checks should be performed, followed by waiting for primary source verification.
Additional communication is often required, including providing additional documentation and clarifications. It’s a complex process because a seemingly trivial detail could lead to a major medical or legal problem later. Your healthcare center’s financial stability also hangs in the balance.
In the best-case scenario, the credentialing process takes about 90 days. A slow or error-prone credentialing process might take up to 180 days, so a smart strategy is to estimate a 120 to 150-day credentialing period and attempt to beat it through strategic revenue cycle management practices.
Mistake #2 Failing to Set Firm Deadlines
Collecting and sorting credentials takes time, so the process often lasts longer than expected. It’s common for the staff at a healthcare center to become overwhelmed and frustrated about the cumbersome nature of medical credentialing.
Set realistic deadlines to help your team members manage their expectations for the timeframes and tasks involved with the process. Create a routine of checking and submitting data on a regular schedule to minimize issues that can slow things down. Over time, your proactive deadlines will speed up the revenue cycle for your entire organization.
Don’t rely on backdating to help your facility complete credentialing. Backdating is one of the biggest mistakes a healthcare center can make because it relies on unknown and unverified details. Until an application is officially approved, you can’t count on it for reimbursement.
Mistake #3 Not Using Digital Data Sources and Processes
Digital processes minimize errors and prevent duplications and wasted work. Below is a list of common credentialing issues that can be mostly resolved through electronic options.
Typos and keystroke errors
Human error is hard to avoid, but digital processes help minimize mistakes. An electronic database may be able to detect keystrokes with wildly incorrect values. Your digital system could catch misspelled names, nonexistent postal addresses, incorrect license numbers, incorrect medical codes, and much more.
Omissions
Be sure to go through each payer’s application closely and supply all required information to ensure that everything is accurate. Around 85 percent of all medical credentialing applications contain missing, inaccurate, or or out-of-date information. The only way to meet the optimal 90-day credentialing time is to get each application right the first time. Manual data entry is prone to omissions, but digital systems usually catch empty fields and prevent progression through the document until the proper information is entered.
Improper/incomplete documents
At a busy healthcare practice, a worker might become distracted and abandon a document. They might also become confused about the process and inadvertently close or delete a document before it’s completed and submitted successfully. Digital systems send alerts to prevent these scenarios from interfering with smooth credentialing and reimbursements.
Lack of authorization
Many types of documents require proper authorization or they will be rejected during the credentialing process. Choose a digital system with fail-safes to prevent proceeding with submissions without the right authorizations.
Poor tracking
Track the statuses of your submissions and resubmissions. Address any interruption, like a request for additional information, quickly and smoothly. Although your clinic staff might be busy, requests for documentation and follow-up must not go unaddressed.
Mistake #4 Ignoring State Regulations and Compliance Rules
In the U.S., every state has healthcare credentialing requirements. Insurance companies and major reimbursement sources like Medicare and Medicaid also have regulations to follow.
Educate your staff on the full range of rules and requirements, keeping them up to date on any changes. Alternatively, you can hire a medical credentialing specialist to handle your credentialing and lift this burden from your staff, which is an option discussed in more detail below.
It takes training and practice to stay ahead of insurance and regulatory changes, but it’s worth your time to get it right. Delays and denials can ultimately destroy the positive financial margins of your healthcare center.
Mistake #5 Not Credentialing With CAQH
The Coalition for Affordable Quality Healthcare (CAQH) is a nonprofit group establishing a uniform credentialing program for healthcare providers, plans, and reimbursement sources. The CAQH encourages all of these organizations to work together cohesively in a collaborative process that uses resources wisely.
Credentialing and re-credentialing are much faster and easier with CAQH. Keep your providers up to date with CAQH and each time you bring a new doctor on board, pre-credential them to ensure everything is fully in place before they see their first patient.
Any healthcare provider or plan can use CAQH to access resources and best practices for credentialing but be advised that CAQH’s provider user guide is long and complex. If you opt to work with a credentialing partner, double-check that they have extensive experience using CAQH to optimize the process.
Medical Credentialing: How Altruis Can Help
Did you know Altruis handles medical credentialing? We also facilitate fast and revenue-focused coding, billing, reimbursement, and many other types of revenue cycle management activities. You can trust us to accelerate your payment cycle while allowing you to keep the focus where it belongs: on your patients.
Schedule a call with Altruis for greater insight into the successes and challenges of your current medical credentialing process. We have the knowledge and methodology it takes to help you avoid mistakes, maintain strong profitability, and provide outstanding healthcare.
