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Support Medical Credentialing – 98,000 Americans Will Thank You

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May 21, 2021

How well do you know your doctor? Are you willing to trust her with your life? Do you know what may be in his past? While many people choose new healthcare providers every day, they rarely need to think deeply about these critical questions due to the credentialing process doctors and other health service providers must complete. Without a credentialing process, the public has no way to determine if a doctor is competent, properly trained in their specialty and working within commonly accepted rules regarding medical care.

Why Proper Credentialing is required?

Proper credentialing is essential to build trust between patients and providers such as physicians, nurses, therapists, medical assistants and many other medical professionals. Without this trust, the healthcare system as we know it could not exist. But there’s other reasons providers need to be credentialed as well.

  1. Lowering Medical Error Rates – Every year, 98,000 Americans die because of medical mistakes. Credentialing of providers can lower this number by ensuring provider competency and inspection of past provider history.
  2. Insurance Implications – The majority of Americans carry some kind of medical insurance, and insurance companies will not reimburse for claims submitted by providers who are not credentialed with their organizations. While a few payers may later reimburse for earlier insurance claim submissions prior to the completion of the provider’s credentialing process, this is relatively rare and you cannot depend on it. If services are provided by a medical professional who is not yet credentialed by a specific payer, you’re likely to lose that important revenue.
  3. Improving the Reputation of the Medical Office or Facility – When all providers are fully credentialed, the standing of an employer will rise in the medical community.
  4. Assists with Hiring Decisions - During the hiring process, companies can “vet” their candidates by going through a credentialing process, and hold an official job offer until the candidate’s track record is verified.
  5.  Protects the Organization from Lawsuits - Laws exist requiring credentials on legal documents such as prescriptions and clinical documentation. There are also laws regulating professional activities such as legal testimony, speaking engagements, and publishing research papers. If credentialing is skipped, the employer may be subject to legal action for lack of regulatory compliance.

Credentialing

Always keep in mind that a provider’s credentialing does not last forever. If a medical professional wants to accept additional insurances, the process must be repeated every time for each new payer. Many payers also require recredentialing after certain periods of time to ensure the provider’s record is still clear of any issues or concerns and to confirm that the medical professional is keeping current with changes common to his or her specialty. Recredentialing is one of the strongest tools you have when it comes to employee evaluation and employee monitoring.

More and more organizations are seeing the benefits of outsourcing their credentialing process in today’s ever-changing healthcare environment. Some of the most common reasons for outsourcing credentialing include:

  1. Reducing Costs – Companies that offer credentialing services invest significant dollars inbuilding powerful electronic systems to streamline what used to be a lengthy, frustrating paper-heavy process complicated by long submission and review times. Electronic credentialing is much faster and extremely efficient, reducing operational challenges. Most medical practice management software is not designed to handle the demands of medical credentialing.
  2. Improving Flexibility – If you have a need for on-demand healthcare staffing, you’ll need to have someone else handle credentialing issues for you. It’s impractical to try to compensate for employee turnover or have a large pool of doctors and nurses on call who are all appropriately credentialed. At Float Care, we specialize in offering a wide variety of providers who will fill this need for our client companies.
  3. Get the Experts on Your Team – Most likely, you don’t have credentialing specialists on staff. Trust your credentialing to experts who handle it every day to make sure it’s done correctly the first time…and every time. Errors can cost you both valuable time and reimbursement dollars.
  4. Maximize the Value of Your Time – Unless your organization is very large, credentialing is typically done by office managers, billers or even financial department staff. While these employees can help get the job done, their primary talents lay elsewhere, and the time they can spend on credentialing is often limited.

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