Delegated Provider Credentialing

Medical Staff Services, Credentialing Software, Delegated Credentialing, CVO, CredentialingIn an era where time and money are in short supply, healthcare organizations are continually examining ways to save both. One area of the Medical Staff Office (MSO) where many are finding efficiencies is in the labor intensive process of credentialing providers.

Credentialing in healthcare is the art of verifying a provider is who they say they are, is someone that you want on staff, and possess the required training and skills to perform specific functions at your facility. Generally, this responsibility lies with the MSO and consists of validating education, work history, licensure, certifications, insurance, references, privileges held, etc. This process is time consuming –taking three to six months depending on the provider, the state of practice, and the workload of your medical staff.

Making credentialing more burdensome is the requirement which forces all healthcare providers to be re-credentialed a minimum of every two years. If a provider is working in multiple facilities (even within the same organization), he or she must be credentialed and re-credentialed at each facility.

Does this resemble a process you’re familiar with? If so, there is a solution...

Delegation!

According to regulating bodies (e.g. The Joint Commission), a healthcare organization is allowed to ‘delegate’ the verification of a provider’s credentials to another group. There are two primary options to consider:

  1. Outsource to a Credentials Verification Organization (CVO) - whose sole business is to perform primary source verifications for multiple healthcare organizations.

  2. Create an Internal CVO – a central office, managed by your healthcare organization, which performs primary source verifications for all providers across all facilities.

Benefits

There are four primary and strategic benefits to utilizing an internal or external CVO. Using an example where a provider performs procedures at four facilities within your organization, your organization will see improvement in:

  1. Medical Staff Workload - When a provider works at four separate facilities, four separate MSOs must individually verify the same credentials. Centralizing this process will optimize the verification of credentials so that it will only need to be performed once every two years (rather than four times every two years).

  2. Provider Time – In the traditional scenario, a provider must complete all of the required documentation, sign and send in necessary forms/copies at least twice a year, taking hours (if not days!) to complete. Centralizing this function will allow your providers to do what they do best - see patients.

  3. Revenue – There is a direct correlation between a provider’s time and the number of patients that can be seen in a day. An increase in the number of patients seen equates to increased revenue, and potentially higher reimbursements.

  4. Patient Satisfaction - Centralizing the Initial Credentialing process will allow providers to be on-boarded more efficiently so they can begin working sooner; and faster onboarding decreases scheduling time resulting in improved patient satisfaction.

Moreover, with delegated credentialing and only one provider record to manage for all facilities, your MSO will operate more efficiently. The medical staff will have more time to focus on facility specific responsibilities including board approvals and privileging.

If your organization has two or more facilities where providers are being credentialed, you should consider the benefits of delegated credentialing. Delaying the decision and not taking advantage of these efficiencies will end up costing your organization valuable time and money.

Provider Credentialing


Melissa Outlaw

About the Author
Melissa Outlaw

Melissa Outlaw is a Vice President, Customer Success with symplr. Melissa and her team assist clients in learning and implementing our provider management software - credentialing, privileging, peer review, quality and event reporting applications. She supports clients in benchmarking current internal practices, identifying potential efficiencies, then driving the integration of technology with process improvement to reduce time of service and operating expenses. She works extensively with decentralized, multi-facility organizations in transitioning to a shared service center as well as assisting healthcare organizations bridge the gap between procedures performed by a provider and their privileges granted.

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