Why Is Credentialing Vital in Healthcare?

We are aware that appropriate credentialing is a crucial component of any operating medical facility. Administrators must have a thorough understanding of provider credentialing in order to ensure that daily operations run smoothly. This includes knowing what provider credentialing is, how it is carried out. Best practices for provider credentialing, and the potential time and resource commitments involved.

To that aim, this book will look more closely at the advantages of good credentialing procedures for your healthcare facility as well as the effects of credentialing on medical professionals and their patients.

A Simplified Overview of the Credentialing Process

Let’s go through the fundamentals of the credentialing process before we look at real-world instances of why provider credentialing matters for healthcare facilities.

In a nutshell, credentialing is the process through which a medical facility confirms the credentials of potential medical practitioners they wish to hire. Employing Licensed Independent Practitioners, or LIPs, necessitates this verification procedure in particular. Those who are “permitted by law to conduct patient-care services without direct supervision” are known as LIPs. 1

State laws differ about who is permitted to practice as a LIP, however it often includes those who hold the following licenses:

  • MD diplomas
  • DO diplomas
  • PhD titles
  • Psych. D. degrees

Nurse practitioners are also allowed to operate as LIPs in a number of states.

How to Check Someone’s Credentials and What You’ll Need

Prior to enabling a LIP to operate in your facility, you’ll need to obtain credentials. Which include more than just a degree from a medical school or other comparable institution. Not at all.

The enormous amount of data that must be acquired is actually one of the biggest sources of annoyance for people during the credentialing process. These things typically consist of, but are not limited to:

basic information such as name, birthdate, mailing address, and phone number

such as gender, ethnicity, and social security number

  • evidence of vaccinations
  • evidence of a negative drug test
  • a complete history of all prior malpractice complaints, lawsuits, penalties, or other disciplinary proceedings
  • Several references from peers
  • Username, password, and National Provider Identifier (NPI) number
  • evidence of ongoing medical study at a reputable institution
  • Evidence of a professional liability insurance policy that is in force

Process for Obtaining Credentials’ Length

For a single prospective hire, it can frequently take three to six months or longer to complete a thorough credentialing procedure. It can take weeks to make much progress when there is so much paperwork to compile and numerous institutions to contact and request records from.

Even a three to six month period with days or weeks of inactivity can feel like a scurry given the amount of documentation to investigate. Due to the time and resources needed for even one credentialing process, many facilities struggle to maintain a complete and honest commitment to their verification processes. This is one of the credentialing difficulties in healthcare.

These worries are exacerbated by the necessity for practitioners to renew their certifications every two years (except in Illinois, where the time table for credential renewals is every three years). 3 For these reasons, a lot of healthcare facilities spend money on a CVO, or Credentials Verification Organization.

A CVO is a third-party business that outsources the credentialing process. Assisting healthcare facilities with hiring more successfully and accurately while reducing errors.

Why is Credentialing Vital in Medical Facilities Like Yours?

No matter how big or small, general or highly specialized, private or public, your healthcare facility should always place a high focus on completing the credentialing process as quickly, precisely, and completely as possible.

These are just a few of the key reasons why it’s important to appreciate your facility’s credentialing policies. Take steps to make sure they’re carried out correctly every time if you want your healthcare company to continue to succeed or even grow.

Credentialing Increases Trust, for starters

When it comes to effective patient outcomes, trust is the cornerstone of a successful healthcare system. Patients are less likely to be honest and open with clinicians about their medical history, present worries, illness signs and symptoms, and other topics if they lack trust. They also have a lower propensity to adhere to post-care therapy plans.

Patients are more inclined to trust the healthcare system and cooperate with practitioners when they are confident that their doctors. The other medical professionals they encounter with are properly qualified to carry out their duties in a professional manner.

Reason #2: Credentials are Required for Financial Gain

By collaborating with health insurance companies, healthcare institutions and individual medical practitioners can both make money. The agreement between an insurer (or payor) and a healthcare provider is frequently referred to as a payor contract.

There are provisions in payor contracts that specify how facilities and practitioners will be paid by the insurance companies for the patient care services they offer, among other issues.

Practitioners must have all necessary credentials, according to payor contracts, in order for their services to be covered by the agreement and paid for. Therefore, you run the risk of exposing yourself. Your practitioners to financial damages if your medical practice skimps on the credentialing procedure.

Credentialing lowers the rate of medical errors, which is reason #3

With approximately 100,000 deaths annually brought on by medical mistakes. They were the sixth most common cause of mortality in the US as of 2007. 4 These mistakes consist of:

  • Miscommunication
  • prescription mistakes made on doctor’s orders
  • negative medication reactions
  • Patient medical records that are not complete
  • crowded establishments
  • Vacant clinical spaces
  • poorly managed and overly complicated workflow patterns

Even while some of these mistakes are just the result of human error. You may reduce the likelihood of medical errors in general by properly credentialing each practitioner in your medical business.

Reason #4: Having credentials safeguards you from legal action

In court, it will be crucial to have a complete and accurate record of each practitioner’s credentials. By demonstrating that you checked every single healthcare practitioner’s credentials and updated the checks as necessary. You can help protect yourself and your institution from liability in the event that a malpractice claim is made against a healthcare provider working in your facility.

You’ll not only protect yourself from accountability but also save money by avoiding expensive court-related fees.

Credentialing enhances reputation (Reason #5)

The ability to investigate a healthcare provider before choosing to work with them as a patient has been made possible by the democratization of information. As the populace becomes more tech-savvy, this habit of studying and reviewing is growing in popularity—and becoming more crucial for healthcare facilities to take into account.

Individual healthcare providers and healthcare facilities must preserve a favorable online reputation in order to achieve this. Medical credentialing services is a quick and efficient technique to demonstrate a person’s absolute qualification to provide patient care services, enhancing their reputation.

Legally speaking, all patients, regardless of their insurance coverage, may be treated by practitioners who have successfully obtained their credentials. This enables the physician to see more patients, bringing in additional business to your hospital and fostering the growth of the entire healthcare system.

Avoid the hassles of credentialing

The overly convoluted payor contracts put a great deal of pressure to the already challenging processes in provider credentialing. Insurance companies frequently go against your best financial interest by trying to force you to comply with their requirements for certifying your practitioners.

They handle your contracts so you can concentrate on the outcomes of your patients and other daily tasks. They’ll battle for better terms at every turn, negotiate the best prices, keep an eye on the contracts, let you know if anything changes, and monitor them.

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