Refining Your Healthcare Organization’s Credentialing Processes

Credentialing is a complex, time-consuming task. It includes several components requiring thoughtful and careful consideration. In addition to gathering documentation—from current privileges to a valid state license—you have to authenticate qualifications, board certifications, work history, and references to approve clinicians’ privileges and insurance eligibility. A poor system could lead to scheduling problems, cash-flow delays, and other serious issues.

To help enhance your processes, we asked a senior member of our credentialing department at Medicus Healthcare Solutions to share a few tips based on her expertise and insight from working with hospitals, clinics, physician offices, and health systems around the country. Read on for a few suggestions, which might spark additional solutions for improved credentialing experiences.

Review bylaws and relevant documents

If your organization’s bylaws and related documents do not encourage collaboration between medical staff and administrators, consider advocating for their redesign.

“Healthcare is continually evolving; some regulations put into effect years ago may no longer be relevant or offer the best strategy,” states Director of Credentialing, Maureen Locke. “An outdated process creates unnecessary delays. Taking measures to reevaluate and revise—or going back to the drawing board entirely—can smooth over and speed up the credentialing process.”

While approaches for amending bylaws and applicable documents vary in each organization, core bylaws should specify whether proposed changes require a general staff meeting with a quorum or a balloting process for determining next steps. It’s integral to cultivate your medical staff’s acceptance of proposed modifications and concentrate on revisions that connect collaboration with the delivery of high-quality care.

Standardize and consolidate

If your healthcare organization elects to make changes to any credentialing processes, one of the best ways to ensure everyone involved follows the same format—without needlessly duplicated efforts or tasks—is to standardize and consolidate.

“Reexamining the data and documents you collect and send out, as well as making sure everything is uniform, helps,” says Locke. “While it involves some legwork and an initial investment of time, the result will be well worth it.”

Encourage open communication

Let’s say the head of your hospitalist program wants to bring on four new providers—stat! The director of emergency medicine has asked you to focus on the needs of her department, which is extremely short-staffed.  You also are in the process of credentialing two surgical oncologists. Of course, you want to focus on the most urgent need; however, that’s a challenge when you are working on multiple files at once.

“Whether your organization has a credentialing team or one or two people in your MSO who go through all the files, credentialing is a team effort,” says Locke. “It should include all touchpoints, from IT to risk management. Often, there is a breakdown in communication about the need, why it exists, and how to prioritize. Encouraging relationships and a healthy dialogue between all departments helps resolve issues more quickly, establish what gets precedence, and ensure you are not ‘spinning your wheels’ over tasks that do not need immediate attention.”

Similarly, if your organization uses a credentials verification office (CVO) and partners with a locum tenens staffing company for its supplemental physician, advanced practitioner, and CRNA needs, you will likely achieve better outcomes with improved communication and process alignment.

“A CVO does not feel the strain of a physician not getting on staff quickly the same way a facility or practice does because the CVO is not emotionally connected or as close to the actual need within the organization,” adds Locke. “For instance, if a CVO has 18 requirements and a hospital has 30, a staffing firm has to respond to each of them. However, there is likely an overlapping of requirements. Aligning processes and providing the staffing agency with one streamlined list could get providers credentialed much more quickly.”

Verify reappointments

“If you pull a report that calls for reappointment before you start working on it, confirm that both the need and the physician’s availability have not changed,” recommends Locke.

Taking a moment to check on a reappointment is a simple, straightforward step that could end up saving you a good deal of time and energy.

Consider external credentialing resources

Perhaps your lone credentialing coordinator is stretched to the limit. Then again, maybe you do not have the MSO staff to effectively handle the credentialing of a large number of providers for a substantial project. If you identify with either of these scenarios, take heart: external credentialing support is available as a cost-effective solution often incorporated with in-house efforts for greater efficiency.

“Our company introduced credentialing as a service to offer a practical solution for organizations that do not have locum tenens or permanent staffing needs but need help gathering essential information and completing applications,” says Locke. “We have dedicated credentialing professionals who are adept at collaborating with providers and know what to look for, which questions to ask, and how to get results. By working with our company or another external resource, healthcare organizations can eliminate the need for additional permanent or temporary staff—which will require training and time to become skilled and familiar with processes—to satisfy a short-term demand.”

If you choose to work with an outside credentialing resource, make sure you have a thorough understanding of the services they will provide. For instance, can they cross-credential providers and coordinate clinical privileges with MSOs for facilities with multiple locations? Or will they assume start-to-finish management of the credentialing process? Receiving answers up front helps ensure that you get the support you need.

To learn more about Medicus Healthcare Solutions and how we can assist your hospital, health system, clinic, or practice with its credentialing needs, call 855.301.0563 to speak with a knowledgeable member of our credentialing department or an experienced business development executive.

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