Medical credentialing is an essential process for evaluatinga healthcare professional's qualifications, competency, and practice history.By verifying a practitioner's education, training, licensure, and board-issued certifications, you are not only confirming his or her qualifications, you are offering assurance to your payers that the individual meets requirements for practice and reimbursement. In fact, you are endorsing them as the qualified individuals who will be representing your healthcare facility or organization.
To become eligible for reimbursement from commercial payers and government programs (such as Medicare and Medicaid), each provider must complete the process of application, submission, and verification of documentation before receiving committee approval. Although this may seem like a relatively simple and straightforward process, credentialing staff must also factor in their own organization’s specific credentialing criteria along with its unique guidelines, processes, and standards of approval.
With all of this complexity, creating a streamlined credentialing process to protect your organization and ensure that your staff is properly certified becomes a necessity. A weak or inefficient credentialing process can cause serious problems for your organization. If errors occur, or credentialing lapses, you may face discontinuation of provider services, accreditation issues, or risk of malpractice.
Choosing an appropriate credentialing software can save you time, money, and resources – and help you organize, process, and effectively track all of this information for ongoing review and accreditation.
Here are 8 reasons to streamline your process now—
- A weak or inefficient credentialing process can cause serious problems for your organization. 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 suit the workflow needs of teams that have various credentialing staff members working on different parts of the same file.
- Effective solutions are scalable as your organization grows – the right credentialing software can store thousands of records in a way that meets your organization’s needs.
- Spreadsheets are not designed to handle legacy records, but retaining a complete history of a provider is the essence of re-credentialing. Human error can erase information stored on spreadsheets, a problem alleviated through a web- or cloud-based storage solution.
- Traditional communication solutions can limit your ability to share data with providers or other entities. Using email may expose sensitive data to potential security breaches.
- Paper files present a number of challenges – since your storage needs increase over time as each provider’s file grows and as your organization takes on more providers.
- A web-based credentialing software solution protects your data from risks like fire, theft, and flood. As long as you can access the internet (and have the appropriate security rights), 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 selecting and implementing a web-based credentialing solution, you'll lighten the load carried by your administrative staff, allowing them to devote their time, energy, and attention to more immediate, high-priority tasks.
At symplr, we aim to simplify your credentialing. We offer complete credentialing solutions, including robust credentialing, privileging, and provider enrollment software, designed to meet the unique needs of your organization, whether a small practice or a multi-entity health system. We stay up to date on issues surrounding legal compliance, industry trends, and regulatory changes – so you can focus your attention on serving patients.
Looking for more information on how to streamline your credentialing process? Download our webcast, “Credentialing, Recredentialing and Privileging Basics”, and learn how you can design and implement a streamlined credentialing and privileging process.
This is an update of our previous blog post, "8 Reasons to Modernize and Streamline Credentialing."