What are Credentialing Issues and Resolution?

Credentialing. It could be seen as the necessary evil for any healthcare organization, but particularly

medical practices. You can’t treat patients without proper credentialing in place, but it’s time

consuming, there are ongoing regulations to keep up with, and costly legal implications can be

associated if credentialing lapses. Here’s a glimpse into some of these issues and a resolution.

While it’s imperative that each and every physician is properly vetted and credentialed prior to

practicing for numerous reasons, the tedium that goes into the process can steal valuable time away

from patient care, scheduling and billing – also tasks incredibly important to overall business operations.

Compound all of this with the explosion of credentialing requirements and paperwork, staff can take up

to 3-5 hours each day on credentialing.

Today’s healthcare industry offers numerous challenges that lend to strapped staff time. Requirements

for hospitals and healthcare organizations continue to grow with Meaningful Use and HIPAA. As of

January 2013, only credentialed medical assistants have been permitted to enter medication, radiology,

and laboratory orders into the EHR to count toward meeting the Meaningful Use thresholds under the

Medicare and Medicaid EHR Incentive programs.

With the growing complications and tediousness of credentialing, the risk of error exists, and the

ramifications of incorrect or insufficient credentialing can cost practices and hospitals dearly. Payer

processes can be slowed, patient-risk is increased and organizations can pay hefty fines in malpractice

situations if proper paperwork is not produced.

A resolution? To best manage this oftentimes complicated task of physician credentialing, practices and

hospitals can look to vendors well-versed in the space that can securely manage the process for

credentialing and re-credentialing. Vendors should have the ability to manage profiles and documents

for physicians, help monitor for expiring credentials and have a dedicated, knowledgeable staff to

answer any questions about the process in general. Save time, save money, save the legal headaches.