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Why Is Credentialing Important in the Healthcare Field?

Update Date: Mar 01, 2020 08:41 AM EST
Why Is Credentialing Important in the Healthcare Field?
(Photo : Why Is Credentialing Important in the Healthcare Field?)

There's currently a serious problem in the healthcare industry. It has to do with verifying the credentials of medical professionals.

The results of one survey showed that 52 percent of ambulatory organizations were not in compliance with credentialing guidelines. The same was true of 47 percent of office-based surgical facilities.

A lot of healthcare providers and administrators don't understand the necessity of credentialing when it comes to keeping patients safe and ensuring that their practices run smoothly. If you're part of this group, keep reading to learn more about what credentialing is and why it's so important.

What Is Credentialing?

The credentialing process is a formal process that verifies the providers' qualifications. It checks their training and licensure, too.

This process ensures all providers get held to the same standards. It also prevents important information from falling through the cracks.

Benefits of Healthcare Provider Credentialing

There are lots of reasons to make a proper provider credentialing process a priority. The following are some of the most noteworthy:

Increases Trust

Patients deserve to have faith in the people who are treating them. After all, they reveal a lot of intimate information during their appointments. They should know that the people they're talking to are knowledgeable and have the qualifications necessary to treat them.

Patients also deserve to know that they're receiving the proper treatment for their condition. If they know you have a solid credentialing process in place for your practice, they may be more inclined to continue seeing you.

Prevents Lost Revenue

All medical offices must partner with certain insurance carriers. Part of this partnership involves producing a list of verifications regarding provider credentials to ensure they can be reimbursed for certain expenses.

Without proper credentialing and verification, insurance carriers may not follow through with these reimbursements. This, in turn, can lead to lost revenue and additional expenses for the practice. 

Reduces Error Risk

It's true that, sometimes, accidents happen and are unavoidable. At the same time, though, you can reduce the chances of an accident happening when you make an effort to only bring in healthcare providers who meet certain criteria.

Thorough vetting and credentialing help to reduce the number of medical errors that take place at your practice. It lets you rest easy knowing that everyone who is on your staff is competent and has the training necessary to do their job in the correct way.

Improves Reputation

You don't want your practice to be known as the one that employs unqualified practitioners. Even if you take care of an issue in the quickest and quietest way possible, news like this has a way of getting out.

Do you want your practice to be taken seriously and recommended by current patients? If so, it's imperative that you prioritize good credentialing practices. Otherwise, you could find yourself (as well as the practice) facing a PR nightmare.

Protects Against Lawsuits

Proper credentialing also helps to protect your practice from lawsuits. It does this in a couple of different ways.

First, many states have laws in place requiring the listing of credentials on legal documents. This includes prescription records and medical records. If credentials haven't been verified and aren't listed, your practice could be vulnerable to a lawsuit.

Credentialing also helps to protect the practice from potential malpractice lawsuits. What if a provider makes an error because they're unqualified? What if they're found guilty of malpractice? That could spell big trouble for the office that chose to employ them. 

How to Improve Credentialing Processes

Okay, you can see that you need to take provider credentialing more seriously. How can you go about improving these processes, though? Start by taking these steps:

Understand State Regulations

First, make sure you have a clear understanding of the regulations and requirements for physicians practicing in your state. Knowing what's expected will help to make the vetting process easier. It'll give you a checklist to follow to ensure you're not missing anything important.

Assign a Credentialing Coordinator

At first, the idea of improving your credentialing processes along with everything else might seem like more than you can bear. This is where having a credentialing coordinator can come in very handy. A credential coordinator's job is to spearhead the practice's credentialing efforts.

Establish a Clear Credentialing Workflow

Once you've appointed a credentialing coordinator, work with them to establish a clear credentialing workflow. The more you can streamline the process, the easier it'll be for them to work in an efficient way. They'll also be able to verify providers' credentials without using up tons of time and practice resources. 

Set Clear Expectations for Providers

When you're looking to hire new providers for your practice, be clear about what qualifications they need to have before they apply. Some people will still apply even if they don't meet the necessary criteria, of course.

However, setting clear expectations will help to weed out some of those who aren't qualified. It will also help to make the job of the credentialing coordinator easier.

Use Credentialing Software

Don't underestimate the value of credentialing software, either. If you don't have the budget to pay a credentialing coordinator, the right software can make all the difference. It'll help to speed up the process and minimize errors so you can save time, reduce costs, and still get the job done.

Learn More About Credentialing Today

Now that you know more about credentialing and the benefits it provides, are you ready to level up the credential process for your practice? Follow the guidelines laid out above so you can step up your approach to credentialing, save money, and manage your providers with ease.

Do you want to learn more about improving your approach to healthcare practice management? If so, we have lots of other resources available on our site. Check out the latest healthcare news today.

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