Top 5 Credentialing Issues In Healthcare You Must Know About
As a healthcare organization, one of the greatest challenges for you is to verify your practitioners’ qualifications. These qualifications mainly include their education, residency, practice history, and licenses. This process of verification is called credentialing, and it is a vital step for a healthcare professional to be able to start or continue their practice. As for healthcare organizations, they need properly credentialed practitioners for uninterrupted patient care.
That said, credentialing is as challenging as it is necessary. This is because of certain issues that cause hindrances to the verification process. These issues can prevent practitioners from getting authorized to practice. This ultimately causes a financial burden on the healthcare facilities they work in.
It is noteworthy that attending patients while being uncredentialed can cause serious legal troubles for the provider and their healthcare organization. More specifically, any harm to the patient during or after the treatment can bring up a case of negligence. This can result in a medical malpractice lawsuit.
In this blog, we will discuss the most common credentialing issues in healthcare. We will also cover the effective ways to avoid them. So read on.
Top Challenges In Healthcare Credentialing
Outdated Information
One of the major challenges for healthcare organizations regarding credentialing is assessing practitioners’ information. This is mainly because most practitioners do not update their credentials in the system on time. As a result, the healthcare facilities they work for have a hard time getting the latest information about their licenses and practice history. And it costs extra time and resources. It is, therefore, vital for healthcare practitioners to get their information reviewed and re-attested in the CAQH database before their credentialing application is processed.
Complex Requirements
Credentialing requirements can be tough, especially if you are a small practice. This is mainly because of the changing regulations, which can be hard to keep up with for solo practitioners or small clinics. The most challenging aspect of these requirements is keeping track of a practitioner’s education, training, work history, licensure, and criminal or malpractice record.
Lack of Human Resource
Another significant challenge in healthcare credentialing is the lack of staff members who can verify practitioner’s information. If you look at the credentialing process, you will easily notice its time-consuming nature. And the fact that many of its steps involve manual data handling makes it labor-intensive. Even a larger staff may find extensive documentation hectic or even frustrating.
Compliance Requirements that Vary From State To State
Laws related to healthcare credentialing can vary from state to state. Here, it is worth understanding the reciprocity rule. This rule allows practitioners credentialed from one state to practice in a reciprocal state without getting relicensed. However, the challenge occurs when a healthcare provider goes to a state without the reciprocal rule. They must get the necessary certification and undergo the licensure process before they can legally practice in that state.
Even in a reciprocal state, not all credentialing requirements are the same. They can vary based on the medical specialty, qualifications, and the licensing process.
Poor Time Management
This is indeed one of the most significant challenges in medical credentialing. Many healthcare facilities act quickly to hire practitioners while putting the credentialing process second in the queue. As a result, the providers become entitled to a paycheck before they are cleared to treat patients. Those providers remain a financial liability for their organizations until they get a clean chit.
Other issues that healthcare facilities can face by delaying credentialing include:
- Medicare compliance problems
- Nonpayment of reimbursement money
- Increased backlog of patient schedules
Steps To Overcome Healthcare Credentialing Issues
Although challenging, healthcare credentialing is a manageable process. In fact, you can get your practitioners credentialed without any issues. All you have to do is stick to a few best practices, such as the following:
- Perform credentialing as the top priority. Even though it may take some time initially, there won’t be many other issues left to bother you. Get the practitioner’s information and verify it before getting them enrolled.
- Ensure compliance with state guidelines. This will be particularly helpful when you have applicants from other states. Look into every incoming practitioner’s license, educational credits, and certifications. You may also look into their interstate licensure. This will help you prevent the hassle of running the credentialing process from scratch.
- Invest in automation and technology. While much of the healthcare credentialing process involves manual data entries, you can expedite many of its laborious steps with AI. This automation can, in fact, shorten the overall verification span.
- Outsource healthcare credentialing to third-party companies. This is one of the most effective and easiest ways to streamline your credentialing process. A dedicated credentialing service has a specialized workforce to handle all aspects of credentialing. You can hand them over this process and rest assured of the procedural accuracy. However, it is important to analyze a company thoroughly for authenticity and expertise before you avail of its services.
Final Thoughts
Credentialing is a vital process for a healthcare organization to run smoothly. It allows them to ensure they get only expert practitioners on board. It is also a major compliance requirement set forth by healthcare authorities and insurance companies. Any issues in this process can lead to delayed payments and even legal pitfalls like malpractice lawsuits.
Staying on top of credentialing requirements can help prevent its issues. But given its complex nature, outsourcing it can be the safest bet. One of the companies you can choose in this regard is AltuMED. We provide companies with complete practice management solutions, including detailed credentialing. We have thoroughly trained, seasoned experts who work dedicatedly to uplift your healthcare facility.
Subscribe to Our Newsletter!
Subscribe to Our Newsletter!
Enter Your Email Address. We Promise We Won't Spam You