Avoidable Credentialing Risks

There’s a lot to keep up with in managing physician relationships in a medical practice or health system. Much has been said about the countless tasks and risks associated with provider credentialing. Why not identify and minimize those risks?

Ineffective credentialing permits unqualified physicians to practice and qualified physicians to practice beyond their current demonstrated competencies, creating a filling pool of risk.

Financial Risk

Certainly a significant financial exposure exists from lost referrals or time away from a practice as a result of a lapse in credentialing. Lost opportunities to gain referrals or time spent revisiting the credentialing process are long term financial losses that cannot be recovered.

Hospitals and physicians also face undue legal risks associated with an incomplete or inefficient process. Potential legal fees and litigation support associated with improper credentialing are expensive but avoidable. Addressing policy and procedure is a prudent risk management strategy.

Practical Risk

Often the most solvable but difficult tasks faced by a practice is identifying, investigating and addressing quality performance issues within the group. Seldom resolved in a timely fashion, these challenges are often generated by the lack of a predefined and repeatable credentialing process.

Without a systematic and methodical process, issues continue in perpetuity and are often overlooked or ignored in hopes they won’t surface in the future. Unfortunately, patient injury happens even under the best of circumstances and the likelihood of patient injury is multiplied when the credentialing process has failed.

Recruiting Risk

Recruiting and retaining qualified, committed healthcare professionals is an expensive and continuous challenge. Key to that success is a workplace emphasizing excellent care in a respectful and collaborative environment. A quality driven credentialing process can support excellence and identify applicants who further that goal, increase retention and reduce your entire risk profile.

Provider Credentialing


Jim Leonard

About the Author
Jim Leonard

Jim serves symplr as the business development leader of Provider Management and Payor Enrollment. He brings more than 20 years of highly successful sales, marketing and consulting leadership to symplr. His team’s focus is to aid clients with the identification and resolution of gaps in current credentialing, privileging, peer review, quality, and event reporting programs. Jim’s insight into utilizing technology to create transparency and improve operational efficiency promotes overall improvement in provider and hospital performance; further aiding clients in meeting or exceeding compliance with governing body requirements such as CMS, JC, DNV, and CIHQ.

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