Medical Credentialing Mistakes No One Talks About

Medical credentialing is a rigorous and complicated process. Any wrong miscalculation can cost you money and valuable time. Verification of providers credentials looks like a straightforward activity, but there a glaring mistake can expose the hospital to liability.

The revenue cycle of any medical facility relies on proper medical credentialing. Here is what you need to do to avoid when handling medical credentialing.

Employ Adequate Staff

Credentialing is labour intensive processes that need several people who are keen and can pay attention to detail. Apart from the usual long list of certifications available for verification, every detail about a provider needs scrutiny. Employ staff with the right credentials such as good employment history, have the right license, and has the minimum educational requirements.

Make Resources Available

Medical credentialing even for a single provider requires going through a lot of paperwork, data, and forms. If you fail to allocate enough resources for all involved in the process, there is a possibility of losing revenue, overworked personnel, and an endless pile of unfinished work.

Not Knowing When to Outsource

You may want to hire a firm specializing in medical credentialing services to reduce the workload and increase efficiency. A provider may not accept any mistakes made when compiling data and as a result, delay the reimbursement process. An error such as poor background checks increase the chances of a suit, which may damage the hospital’s reputation.

Incomplete Applications

A single provider has a lot of information and data that needs filling. Failing to fill every item on the application with the correct information will bring more delays and may prompt the provider to deny coverage. Using software applications for verification of such data is vital to ensure seamless operation.

Failing to Update Information

Operating licenses renewals take place regularly in line with the country or law in which the service is registered. A proper medical credentialing service ensures that healthcare provider’s information is up to date with all their respective boards and certifications. If your credentialing records are not the most recent, then medical practitioners may be performing services without proper licensing information. The outcome of this is possible malpractice lawsuits.

Signs of Laxity

The process of getting a single provider’s details can take up to 3 months if all the necessary paperwork is complete. Working with an organized team to verify and vet the companies the process can take a much shorter time. You should be able to foresee likely problems linking the patient, the physician, and the insurance company, which if not handled early enough will cause more problems to the hospital.

Some Professionals Working out of Network

When you are dealing with a healthcare professional who works outside the providers’ network, they tend to receive lower reimbursements.

Lack of Response to Emails

Ensure that you work with practitioners who acknowledge receiving communication from you. Also, confirm if they are compliant with the patient health information privacy policy.

Apart from the medical team placing its focus on helping with solving issues related to credentialing, the important thing to remember is that improving the quality of healthcare should be your number one goal.

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