STREAMLINING PROVIDER ONBOARDING AND CREDENTIALING

LESLIE JEBSON MHA, MBA, FACHE, FACMPE Executive Director – Clinical Strategy & Initiatives Texas A&M Health, College Station, Texas e/jebson@tamu.edu

Presenter reports no conflicts of interest as of time of presentation.

§ Manage current challenges and opportunities for new provider onboarding and payer credentialing processes

§ Discover opportunities for process streamlining and technology adoption that expedites credentialing administrative processes

§ Apply improvement strategies for internal staff practice processes for effective provider onboarding

LEARNING OBJECTIVES

©2021 MGMA. All rights reserved. - 4 -

NEW PROVIDER ONBOARDING

§ Wasted labor and financial costs involved with recruitment

§ Lost or reduced access to clinical care services in your market

§ Cultural-Morale disruption (why are these doctors leaving?)

§ Lost organizational professional/ancillary revenues $$$

‘An estimated 35-50% of physicians will leave their new job within 36 months’

https://www.mgma.com/resources/human-resources/combat-the-turnover-traphttps://www.mgma.com/data/data-stories/please-don-t-go-ways-to-reduce-physician-turnover

©2021 MGMA. All rights reserved. - 7 -

©2021 MGMA. All rights reserved. - 8 -

WHEN A NEW PROVIDER WALKS INTO AN ORGANIZATION..

WHAT IMPRESSIONS ARE BEING MADE?

FIRST IMPRESSIONS

§ Everyone likes to feel valued and creating an

atmosphere of organization and quality is paramount.

A well-organized orientation can help enhance

physician performance and retention.

§ Remember-Quality physicians, NPs, PA’s are often

in short-supply

Newbie

ONBOARDING A NEW PROVIDER(we will get into each of these)

§ Get as much ‘administrative stuff’ out of the way before day 1 as possible

(we will discuss this more in the new provider credentialing section)

§ Establish a resource list/welcome kit of key organizational contacts and items

§ Establish a ‘concierge’ point person as the ‘go-too’ primary resource

§ If possible, Identify a mentor peer physician

§ Quality physicians aren’t sitting around waiting, when you get a good one, work

diligently to make their new transition as seamless as possible

ACTIVE INTERNAL AND EXTERNAL RECOGNITION AND PROMOTION

COMMUNITY RESOURCES: Mail it to the new provider, to their house, or email it ahead 

of time, or have it waiting in their new office 

https://www.karenzupko.com/wp-content/uploads/New-physician-onboarding-checklist-050216v2.pdf

https://www.aafp.org/fpm/2019/0700/p24.html#fpm20190700p24-ut1

https://etactics.com/blog/welcoming-new-doctor-to-practice

BE HIP TO TECHNOLOGY (create an app or text information for automatic 

downloads)

https://www.qr-code-generator.com/ https://www.youtube.com/watch?v=NtwCTo7T9zg

ESTABLISH A PRIMARY CONTACT AS CONCIERGE

Credentialing PaperworkEMR training and access

Best Doggy Day-Care

Office Keys, and First Day Tour

A Good Realtor

Getting an Employee ID

IDENTIFY AND PROVIDE A RESPECTED PHYSICIAN PEER RESOURCE

Physician onboarding needs to include not only policies and procedures but also social engagement and training related to the specific practice model.

PROVIDE ROUTINE UNDERSTANDABLE DATA

Set a reasonable and gradual plan to help the new physician reach performance goalsWhen might they breakeven? When might they be eligible for incentives? How many new patients are they gaining per month?

NEW PROVIDER CREDENTIALING

WHAT IS CREDENTIALING?

Medical credentialing is one of the most important operational, financial, morale-effecting, compliance-based

concerns in medical practice today. It can be a frustrating, time-consuming, and a complicated process. If not

done accurately, the medical practice will suffer valuable losses in time and money, as well as feel an impact

on provider morale. A poor medical credentialing system may not only lead to enrollment issues but also to

legal and financial complications.

Credentialing is a process of verifying and assessing a health provider’s qualifications, including education,

career history, training experience, residency and licenses in specialty certificates (if any) and other

qualification details. This information is assembled and coordinated with health insurance companies that the

medical practice has agreements with.

PROVIDER CREDENTIALING AND PRIVILEGING§ Credentialing is the process by which a healthcare organization assesses and confirms the qualifications of a

practitioner. This process ensures that individuals who are providing care are qualified to do so.

§ Privileging is the process of authorizing a licensed or certified healthcare practitioner’s specific scope of patient care services. Privileging can be performed in conjunction with credentialing and includes the evaluation of an individual’s clinical qualifications and/or performance.

§ Historically, credentialing and privileging were mainly associated with hospitals. Now these processes also are essential at other types of healthcare facilities, such as ambulatory surgery centers, long-term care organizations etc.

§ Credentialing and privileging have become complex processes for various reasons, including providers’ expanding scopes of practice, the varying requirements of third-party payers (e.g., the U.S. government and private health insurance plans), and organizational standards (accrediting bodies).

Introduction to Privileges: Credentialing versus Privileging and CMS Requirements

CREDENTIALING CONSIDERATIONS

Compliance Monitoring - Federal, state, and local accrediting bodies are monitored for complaints and disciplinary actions to be sure providers are licensed, accredited, and in good standing.

Delegated Credentialing - Delegation can expedite the credentialing process. Delegated credentialing significantly improves an organization’s efficiency, provider experience, and revenue cycle management (i.e. Insourcing vs Outsourcing).

Primary Source Verification (PSV) - is required for confirming that an individual possesses a valid license, certification or registration to practice a profession when required by law or regulation. It is the responsibility of the accredited organization to complete PSV, not the licensed individual.

TO BE, OR NOT TO BE…. OUTSOURCING vs INSOURCING CREDENTIALING 

SERVICES INSOURCED

$33k-$50k Credentialing Specialist + benefits, large training curve if not experienced, tight labor market (just

search the web and see)

OUTSOURCED SERVICESPay new enrollment 1 time fee $250-$600, pay monthly

fee $66-$129 per month, some local companies, but more national companies through consolidation, frequently offshore staff working on credentials, hit or miss over

quality and diligence.

STATE-SPECIFIC PAYER RULES AND REGULATIONS

Contract Signing Credentialing

Licensing See Patients

©2021 MGMA. All rights reserved.

STREAMLINING INSOURCED CREDENTIALING

INVEST IN THEIR SUCCESSPROMOTIONAL OR QUALITY INCENTIVE EMPLOYMENT MODELS

§ Invest in Professional Membership and Certifications

§ Depending on the size of the medical group and flexibility with employment guidelines, consider creating a structured employment model:

§ Variable or permanent incentives for:§ increases in compensation for continued education, completion timelines, accuracy

©2021 MGMA. All rights reserved.

INVEST IN THEIR SUCCESS

©2021 MGMA. All rights reserved.

INFORMATION - DATA MANAGEMENT

THIRD-PARTY SOFTWARE SOLUTIONS VS HOME-GROWN DATABASE

§ Your EMR vendor may have an integrated solution to deploy? § There are numerous 3rd party vendors § Does the size of your medical practice warrant a 3rd party solution?

§ Can a Vendor Software safely interface with your EMR or Business Analytics?

LEVERAGE TECHNLOGY: Adobe / DocuSign

GETTING OUT IN FRONT OF THE START-DATETime Management Considerations

§ The medical credentialing process plays a critical role in your organization’s

revenue cycle.

§ In the overall process, the review of the applications alone will take up to

90+ days for an organization. When considering the additional stakeholders

like insurance providers – the processing can take up to six months

§ CMS and some Payers Allow for Retro-billing

§ Credentialing should be incorporated into the hiring process/start-dates

(i.e., the clock starts when the provider signs their employment agreement-

not their start date)

ESTABLISH A BACK-UPREFERENCE GUIDE WITH PROCESS MAP

(yes-you can call me ‘old-school’)

PAYER ACTIVATIONS

To mitigate denials due to credentialing status,

credentialing staff control and update each provider’s payer

plans directly into the EMR. This is coupled with eligibility

verification tools. The front-desk/scheduling staff do not have

to think about it.

ü Leverage Technology Where and Whenever Possible

ü Remember 1st Impressions and Getting out of the Gate 1st

ü Detail, Structure and Process Electronic and on Paper

ü Make the time to Train and Carefully Invest in Staff or your Vendor Partner

LESLIE JEBSON MHA, MBA, FACHE, FACMPE

Executive Director – Clinical Strategy & Initiatives Texas A&M Health, College Station, Texas p/979.436.9233 e/jebson@tamu.edu