Tackle the Unique Aspects of ASC Credentialing

Ambulatory surgery centers (ASCs) credential providers in much the same way as other healthcare organizations with some unique differences. The Accreditation Association for Ambulatory Healthcare (AAAHC) and The Joint Commission have extensive credentialing and privileging requirements for ASCs. These standards are not easy to meet when procedures range from minor surgeries to more complex interventions – primarily on an outpatient basis. By specializing in outpatient care, ASCs must streamline processes, reduce costs, and offer greater convenience to patients. So naturally, ASC credentialing would be at the forefront of new practices and technology.

Let’s look at an ASC’s unique credentialing process, challenges, and how the industry is adopting technology to prepare for the future.

The Credentialing Process for ASC Providers

The credentialing process for ASC providers is similar, if not the same, as in other care settings. The process spans various stages, including primary source verification, work history and reference checks, background checks, and payer enrollment, potentially extending up to 150 days. At a minimum, these are standard documentation requirements:

• National Provider Identification (NPI) number
• Current Curriculum Vitae (CV)
• Copies of professional state licenses and DEA licenses
• Board certification information
• Professional liability insurance information
• Peer and professional references
• Continuing Medical Education (CME) documents

Providers or organizations must also decide which insurance companies they will accept. This initial choice can significantly impact the ASC patient base and operational dynamics. Following this, providers embark on the enrollment phase, a prerequisite for accepting insurance and treating patients.

Many payers require providers to maintain a CAQH ProView profile. CAQH credentialing is designed to alleviate the work for providers because many major payers can access that information without the provider completing a separate application.

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Common Challenges in ASC Credentialing

Revenue is of critical importance in an ASC. According to Becker’s, the average revenue per orthopedic case is $3,719. If the average physician is completing eight cases per week, the ASC could lose nearly $30,000 a week due to credentialing-related delays.

Here are some of the most common challenges in ASC credentialing:

• Complexity of Requirements: ASC credentialing involves navigating various regulatory requirements, accreditation standards (such as those from organizations like AAAHC or The Joint Commission), and payer-specific criteria. Managing and understanding these requirements can be challenging.
• Credentialing Delays: The credentialing process can be lengthy, often involving gathering and verifying extensive documentation, including education, training, licensure, certifications, malpractice history, and references. Delays in this process can delay providers’ ability to practice in the ASC.
• Verification of Credentials: Verifying the credentials of healthcare providers, including their education, training, and licensure, can be time-consuming and complex, mainly when dealing with providers who have trained or practiced internationally.
• Growth and Provider Changes: Many ASCs are growing their footprint, which means more providers to credential and privileges to handle. It can be tough to keep up with the volume.
• Meeting Accreditation Standards: Many ambulatory surgery centers are accredited, which means stricter regulations. Surveyors will often ask for a specific document or date, so the credentialer has to be ready!
• Coordination with Payers: ASCs often work with many payers whose credentialing requirements can vary. Coordinating credentialing efforts with multiple payers adds complexity to the process.
• Communication Challenges: Effective communication between the ASC, physician group, providers, credentialing organizations, and payers is essential for a smooth credentialing process. Miscommunication or lack of communication can lead to delays and errors.
• Technology Limitations: Some ASCs may still rely on manual or outdated systems for credentialing, which can be inefficient and prone to errors. Implementing and maintaining credentialing software or systems can challenge smaller ASCs with limited resources.

Addressing these challenges with strategic planning and technology can streamline the ASC credentialing process, benefiting providers and patients.

Optimizing Credentialing Through Technology

Adding technology to your credentialing process offers speed and efficiency that cannot be replicated using a manual process. That’s why Infinity Business Insights predicts the global provider credentialing software market, valued at $1.3 billion in 2021, will reach $5.6 billion by 2030. Innovations that offer enhanced accessibility, scalability, and data security are in high demand as FQHCs look for ways to streamline the credentialing workflow.

Automation

Automating tedious and time-consuming tasks such as reminding providers to submit documents and checking exclusions databases helps free up time for credentialers and reduces frustration. Leading credentialing software offers a secure online portal for providers to upload the documents your ASC requires and automated email reminders that continue until completed. You can also automate reminders to stay on top of important deadlines, like re-credentialing and expiration. Automated exclusions monitoring and license verification eliminate the website hopping and waiting — again, freeing up valuable time for credentialers to spend on the tasks that require a human touch.

Workflows

With so many moving parts in the credentialing process, it is easy to miss a step or let too much time pass between steps. Credentialing software offers customizable workflows to keep your ASC process on track so you can submit a complete credentialing packet the first time. Workflows may include a checklist with assignable tasks, reminders, and dashboards showing outstanding items and due dates.

Transparency

Without credentialing software, it is tough for leadership to have visibility into the process — or for the process to continue uninterrupted if a credentialer leaves the organization. With all documents and information in a central provider profile and all actions tracked in one cloud-based platform, anyone with access can see precisely what has been completed and what is yet to be done for each provider. Dashboards can provide this in a high-level view with the enrollment metrics needed to make business decisions.

Real-Time Reporting

The in-depth reporting included with leading credentialing software provides the insight and visibility you need to keep processes on track and share data with leadership through scheduled reports emailed regularly (daily, weekly, monthly). Every ASC operates differently and prioritizes different metrics. Make sure to choose software with customizable enhanced credentialing reporting so you can select the data and filters you need, then save the reports you use most often.

By leveraging these technological advancements, the ASC can enhance efficiency, reduce errors, and maintain compliance, ultimately improving patient care and operational effectiveness.

The Future of Credentialing in ASCs

As the industry moves toward a more efficient future, the role of technology, particularly credentialing software, becomes undeniably central in optimizing operational effectiveness and enhancing patient care quality. The advent of AI to enable efficiency in credentialing processes not only promises enhanced security and accessibility but also paves the way for a more seamless healthcare delivery system. For those looking to advance their ASC credentialing process with cutting-edge technology, explore how MedTrainer Credentialing Software can significantly reduce turnaround times and improve accuracy, marking a pivotal step toward operational excellence and unparalleled patient care.