Medical credentialing is an essential process for evaluating a healthcare professional's qualifications, competency, and practice history. By verifying a practitioner's education, completed training, residency, licensure, and verification of board-issued certifications, you are not just confirming their competency, you are offering assurance to your payors that each individual is suitable for practice and reimbursement. In short – you are endorsing them as the qualified individuals who will be representing your healthcare facility or organization.
To become eligible for reimbursement from commercial payors and government programs (such as Medicare and Medicaid), each provider must complete the process of application, submission, and verification of documentation before receiving committee or managerial approval. And while it may seem like a relatively simple and straight-forward process, each entity has their own criteria for medical credentialing. This comes with unique guidelines, paperwork, and standards of approval.
With all of this complexity, it is essential to create a streamlined credentialing process in order to protect your organization, and ensure that your staff is properly certified. Choosing an appropriate credentialing software can save you time and money – and help you organize, process, and effectively track all of this information, for ongoing review and accreditation.
Why focus on streamlined credentialing? Though it may seem like a routine administration exercise, a poor credentialing process can cause serious problems for your organization.
Here are 8 Reasons to Streamline Your Process Now—
- If errors occur, or credentialing lapses, you may face discontinuation of provider services, accreditation issues, or risk of malpractice.
- A streamlined credentialing process can help you effectively track the professional qualifications of your staff, decrease administration costs, and ensure regulatory compliance.
- Traditional credentialing methods are time-intensive and inefficient. They frequently involve the use of spreadsheets, personal checklists, and other individual systems, which require constant updates and attention, and don’t translate well to growing teams where different credentialers might be working on different parts of the same file.
- Effective solutions are scalable as your organization grows - the right credentialing software vendor can store thousands of records.
- Spreadsheets are not designed to handle legacy records, yet retaining a complete history of a provider is the bread and butter of re-credentialing – in plain English, if you accidentally click “save” instead of “save as” you could lose critical provider information from a previous enrollment.
- Homegrown solutions oftentimes limit your ability to share data with the providers or other facilities. You can always email, but at best, you may forget to include everyone who needs to be informed, and at worst, you’re exposing sensitive data to potential security breaches.
- Paper files present their own challenges too - your storage need increases over time as each provider’s file grows and as the practice expands and takes on more and more providers. (Note: There’s a potential risk of loss when you’re physically storing records – fire, water damage… even theft.)
- A web-based software protects your data from risks like fire, theft, and flood. If you can access the internet, you can access your records!
If you want to modernize your credentialing department, it’s important to scale to your growing organization, automate your manual processes, and create departmental transparency. By enlisting the assistance of a web-based credentialing software, you'll free your administrative staff of this extensive burden, allowing them to devote more time, energy, and personalized attention to more immediate tasks.
At symplr, credentialing is our primary focus. We offer complete credentialing solutions, including robust credentialing, privileging, and enrollment software, designed to meet the unique needs of your organization. We stay up-to-date on issues surrounding legal compliance, industry trends, and regulatory changes – so you can focus your attention on serving patients.
We are the vendor of choice for hundreds of hospitals nationwide, and we’re committed to maintaining adherence to the most stringent of requirements. For more information on how symplr can help you design and implement a streamlined credentialing process, click here to contact our experts today.