Efficiency First: How to Streamline Your Credentialing

Provider credentialing is one of the last hurdles before beginning patient care, and managers must create efficient workflows to keep up with demand. A perfect storm of impending provider retirement, newly minted physicians, and record-high mergers and acquisitions means that credentialing managers need every tool available to them. 

Griselda Mendez, Credentialing Manager with symplr, and Amy Magnus, MHA, CPCS, CPMSM, Director of Credentialing Operations at symplr, have decades of credentialing experience between them. They recommend regular reviews of your protocols to pinpoint inefficiencies and outdated processes. 

“If the reason you do something is because it’s always been done that way, it’s time to ask some questions,” Magnus says. “Is it the correct way? Is it the most efficient? Is it even appropriate?” 

Magnus and Mendez share five ways to streamline your credentialing process and start caring for patients sooner.

1. Simplify processes: It’s impossible to improve if you can’t objectively examine your processes. Many organizations ask for documentation that goes beyond accrediting standards. Look at these elements and ask if they are truly necessary and still relevant. Paring down extraneous requirements is the first step to streamlining your credentialing. 

2. Know your bylaws: Although they may seem sacrosanct, an organization’s bylaws are the easiest part of accreditation to modify. Thoroughly examine your bylaws–are they outdated? Are they redundant? Every organization should have a revision procedure to edit their bylaws and be willing to use it. Examine the timelines to ensure they are reasonable and can accommodate both expected and unexpected credentialing surges. 

3. Know your accrediting standards: The most important accrediting standard will always be your state and local regulations. While you may assume that accrediting bodies follow state regulations, they may add additional requirements that can muddle the process. Contact the organization for clarification if you don’t understand a requirement or if it contradicts existing government regulations. One question may help streamline your processes for multiple departments. Document your interactions with your accrediting bodies thoroughly in case of audit or review. 

4. Utilize resources effectively: Many large health systems have multiple credentialing protocols. While this redundancy may feel safer, it may also be a wasted effort, creating more work for two departments. Reviewing all accrediting standards can yield valuable insights–often, multiple organizations verify the same information. AOA, AMA, and MPDV can frequently overlap.
   
   The days of manually tracking verifications on spreadsheets are over. Use time-saving software to lighten the load. Not only will this make your job easier, but it will streamline access for other departments that may be able to utilize the same information. The right technology solution can remove the gatekeeper of manual input and create a faster, more efficient system-wide solution. 

5. Measure improvements: Success is best measured with hard data, so make sure you implement metrics that can help you evaluate the efficacy of your processes. Your software should offer ways to measure progress.
   
   Turnaround time is one of the most important metrics, but it is not the only one. Ask your practitioners for their input–is the process unnecessarily difficult? Are there ways to streamline it more effectively? Not only will you glean valuable insights, but you can also forge beneficial relationships for the future. 

As a credentialing professional, your goal is to speed care delivery to your patients. Your protocols should create maximum efficiency to reduce strain on physicians and get them where they need to be–the office.