How To Avoid Negligent Credentialing in ASCs

When people seek care, there’s an implied understanding that the provider treating them is capable of doing so. Credentialing is the behind-the-scenes process that turns this implication into reality, and it’s a critical part of running a responsible healthcare facility. Negligent credentialing practices break this bond of trust, and introduce risk into the healthcare environment.

Negligent credentialing isn’t something any healthcare facility can tolerate. Unfortunately, it can happen accidentally in fast-paced environments like ambulatory surgery centers (ASC).

What Is Negligent Credentialing?

Negligent credentialing occurs when healthcare facilities grant privileges to medical professionals to practice within their facility without first conducting due diligence in assessing their qualifications, competence, and ethical standing. Other names for negligent credentialing include, corporate negligence, negligent selection, and negligent peer review.

When organizations fail to credential physicians, surgeons, or other healthcare providers, they open the door to patient safety risks that could stem from insufficient training, experience, or ethical concerns. This oversight can lead to legal or financial liability for the facility if patients suffer harm as a result of substandard care.

Negligent credentialing can be a recurring issue for ambulatory surgery centers (ASCs), largely due to the complex nature of the credentialing process. ASCs often face pressure to quickly onboard healthcare professionals to meet patient demand, and it can sometimes lead to insufficient vetting.

The Consequences of Negligent Credentialing for ASCs

What happens when an uncredentialed provider makes a mistake in an ASC? Even small accidents can quickly lead to major consequences. Risks are already high in ambulatory environments, and negligent credentialing can exacerbate them in a variety of ways:

Patient Safety Compromised. Negligent credentialing can result in healthcare providers with inadequate qualifications or ethical concerns practicing within an ASC, endangering patient safety and well-being.
Medical Errors and Complications. Underqualified or ethically questionable providers may contribute to medical errors, complications, and adverse patient outcomes, leading to potential harm and litigation.
Legal Liability. ASCs may face lawsuits and legal action from patients or their families if negligent credentialing is proven, resulting in significant financial penalties.
Damage to Reputation. News of a negligent credentialing case can tarnish the reputation of an ASC, leading to decreased patient trust and potential loss of business.
Loss of Accreditation or Certification. Regulatory bodies and accrediting organizations may revoke certifications if negligent credentialing practices are uncovered.
Financial Consequences. Legal costs, settlements, and increased malpractice insurance premiums can put financial burdens on ASCs found guilty of negligent credentialing.
Long-Term Consequences. The fallout from negligent credentialing cases can have enduring consequences to reputation, financial stability, and operational viability.

5 Tips To Prevent Negligent Credentialing

Faced with the pressure to get providers into the field and meet urgent patient demand, ASCs need to develop good habits when it comes to credentialing. Here are five tips to avoid negligent credentialing that every ASC can start implementing today.

1. Document a Standard Process

Establish a standardized credentialing process that outlines the specific criteria and requirements for granting privileges to providers at a given facility. This process should include comprehensive checks of education, training, licensure, malpractice history, and any disciplinary actions. By documenting this process, ASCs can ensure consistency, transparency, and accountability in their credentialing procedures.

2. Follow Your Process

It’s not enough to have a well-documented credentialing process; ASCs must also consistently adhere to it. Make sure all staff involved in credentialing are trained on established procedures, and that they follow them meticulously across the board. Avoid shortcuts or making exceptions that could compromise the integrity of the credentialing process, and have systematic guardrails in place to create accountability.

3. Conduct Monthly Exclusions Monitoring

ASCs should regularly screen all providers against federal and state exclusion lists, such as the Office of Inspector General’s List of Excluded Individuals and Entities (OIG-LEIE). Conducting monthly checks helps identify any providers who may have been excluded from participating in federal healthcare programs, which could lead to legal and financial repercussions if overlooked.

4. Keep All Provider Documentation Together

Maintain a centralized and organized system for storing and accessing all provider credentialing documents. This includes licenses, certifications, application forms, reference letters, and any relevant correspondence. Easy access and up-to-date records can expedite the credentialing process by keeping all necessary information readily available for evaluation and audits.

5. Use Credentialing Software

Use credentialing software or a dedicated credentialing management system to streamline the process and reduce the risk of errors! These tools automate data collection, track expiration dates of licenses and certifications, and provide alerts for upcoming renewals or expirations. Credentialing software can enhance efficiency and accuracy, while keeping the organization aligned to compliance standards.

Being able to fall back on a rigorous credentialing process is critical for maintaining the highest standards of care within ambulatory surgery centers. By implementing these simple tips, ASCs can significantly reduce the risk of negligent credentialing — and safeguard themselves and their patients from risk.

Avoid Negligent Credentialing Using Technology

Risks are high for ASCs that fail to credential providers properly. Thankfully, technology like credentialing management software can play a key role in mitigating these risks.

Credentialing management software streamlines and automates the credentialing process, which allows ASCs to efficiently collect, verify, and track provider credentials, licenses, and certifications. Software also features safeguards to reduce the likelihood of human error, which can speed up renewals and maintain accurate records. Alerts and notifications within the software can even help ASCs stay proactive in addressing expiring credentials, to prevent lapses in provider privileges.

When you consider that the primary reason for negligent credentialing is often a time crunch to get providers into the field, credentialing management software directly addresses many of the root causes behind delays. Moreover, it enhances the consistency and thoroughness of credentialing, to minimize legal and reputational risks for ASCs.

MedTrainer Helps ASCs Prioritize Credentialing

There’s no room for negligent credentialing in any healthcare facility. MedTrainer helps ASCs prioritize credentialing by offering a comprehensive software solution designed to streamline and automate the credentialing process. Our platform empowers ASCs to efficiently collect, verify, and manage provider credentials, licenses, and certifications, to reduce the risk of oversight or errors.

With MedTrainer, ASCs can more easily maintain accurate records, comply with industry standards, and stay on top of credential renewals. Contact us today to learn more about how to minimize the legal and reputational risks associated with negligent credentialing.