healthcare compliance and credentialing

Workforce management should be a primary focus for healthcare organizations, and for good reason. Not only does a well-crafted workforce management strategy and effective technology help lower costs and increase efficiencies, it also plays a vital role in improving patient outcomes and positively impacts staff experience.

Integration is occurring in all facets of healthcare, but we’re focused on a topic close to home: Integrating provider credentialing and payer enrollment (PE) functions. Ask practical questions to eliminate redundancies and share information, regardless of what resources you have, and in spite of what seems like an enormous task.

The Institute for Healthcare Improvement’s (IHI) To Err Is Human (2000) and Crossing the Quality Chasm (2001) reports gave great momentum to patient safety programs and influenced regulations and standards. And yet, “unacceptably high rates of preventable harm….for both patients and the workforce,” remain, the IHI stated. Now, an IHI-led consortium called the National Steering Committee for Patient Safety (NSC) aims to galvanize national collaboration to decrease preventable harm in healthcare.

As discussed in CMS Guidance on Visitors in Long-term Care Facilities, visitation restrictions due to the COVID-19 pandemic have been especially challenging for residents in skilled nursing, rehabilitation, and assisted living facilities. While these measures have been effective in controlling the spread of the virus, they have also left facility residents feeling lonely and isolated as a result.

The signs were there. We’d been telling ourselves that going paperless is a “nice to have” in our world of must-do’s.  We thought: Keying provider data from paper applications into our software makes us digital!  We reasoned: Keeping paper files in our file cabinets is more secure than storing data in the cloud! We denied: Our providers dislike change and will see online applications and virtual committees as onerous! But now we realize that the sand in the hourglass has run out, and there’s little defense against the growing list of reasons why paper must go. 

Your mission, should you choose to accept it, is to be a clandestine gatekeeper of patient safety. An enforcer of rules set by states, the federal government, accreditors, and your organization. A detector of danger within data, to secure revenue. You’ll confidentially communicate, negotiate, evaluate—adapting to the environment and priorities. You will be...an MSP. This blog will self-destruct in 5 seconds.