healthcare compliance and credentialing

They pop up in provider background checks, on payer enrollment applications, in practitioner job time frames, and as malpractice claims. They’re red flags. They—and subtler, so-called pink flags—identify data, documents, gaps, discrepancies, or verbal communications that bring into question the validity, accuracy, or existence of an item in a healthcare practitioner’s background.

The move towards centralized staffing, where a central office manages staffing rather than individual units, began about ten years ago. In the early days of centralized staffing, hospitals simply set up an office with a direct line for centralizing call-ins with staff who could help units fill staffing requests. Over the last 2-3 years, the centralized staffing trend has accelerated as the needs of health systems have changed with growth, expansion and the need for multi-facility coverage. Today, we are seeing more of our customers move towards using a central staffing office to manage all aspects of day-to-day staffing, such as filling vacancies, flexing staff as patient care needs change, managing internal resource pools, and even managing timekeeping.

If your organization still uses hardcopy elements for incident reporting, you’re not alone. Paper reporting forms are a good start, but don’t provide the structure necessary to account for organization wide, event-related information that saves you from trouble down the road. The reasons to go digital with an online incident reporting software program are multiplying, and include improved accessibility, analysis, accuracy, and compliance tracking.

There’s a lot of advice online about how to compare quotes from software vendors. And you’re not imagining things if you feel as if some companies encourage a speedy decision in selecting a provider credentialing software platform. But due diligence is critical because there’s no one-size-fits-all for provider data management.  We offer tips you might not have thought of, regardless of whether you’ve been through the vetting process before. 

As a Customer Success Manager, I’ve seen firsthand how important it is for health systems to find the balance between flexing their staffing plans to meet patient care needs and protecting the bottom line. When patient census and/or acuity increase or staff call in sick, unit leaders need to quickly find qualified staff to fill the gaps. Often, that requires the manager to rely on premium labor to incentivize staff to fill the open shifts at the last minute.

Errors, omissions, and misinformation can seep into the credentialing process despite the safeguards built-in. Credentialing professionals in hospitals and payer organizations know the high risks of failing to identify and correct compliance gaps. Potential patient harm—plus accreditation, legal, and financial trouble can follow. Even in the context of pressure to onboard providers quickly, there’s no alternative to stopping in your tracks when a questionable item appears in a practitioner’s file.