Avoiding Negligent Credentialing in ASCsCredentialing in ambulatory surgery centers (ASCs) must be done in accordance with not only best practices, but also the guidelines set by accreditation bodies. Proper credentialing ensures that patients receive quality care and that all prospective providers are treated fairly.
However, failure to follow a consistent credentialing process or failure to complete the process in its entirety may lead to a negligent credentialing cause of action. In the event of litigation, the veracity of provider credentialing is heavily scrutinized, which can, in turn, lead to greater exposure and liability on the part of your ASC.
What leads to a negligent credentialing case?
When patients or providers bring a lawsuit against an ASC, there can be different causes of action, such as battery, assault or tortious interference with a contract. For example, patients can allege harm from an uncredentialed provider. Or, providers may feel they were unjustly excluded during the credentialing process and bring suit. It is up to the ASC to demonstrate that it has followed a consistent, correct and complete credentialing process. Unfortunately, this is where many practices have historically fallen short.
The losing battle of spreadsheets
For years, the industry standard for managing the credentialing process has been a patchwork method of paper documents and spreadsheets in Microsoft Excel. But on average, a single provider can have over 500 points of information that need to be collected and verified, including medical licenses, peer reviews, education, residencies, malpractice history, and employment history.
The sheer volume of information to keep track of can be daunting for any practice, regardless of size. And now, faced with longer, more exact applications and shorter turn-around times for submissions, those dependent upon spreadsheets as their touchstone are already in a losing position.
Modern technology is the best offense and defense
Spreadsheets are no longer a practical means of tracking of all the requirements. The key to implementing an efficient and effective credentialing process is technology. Consider replacing spreadsheets with an automated credentialing management system. Such a solution prompts administrators to enroll providers and complete each step of the process in the same way, every time.
A credentialing management system can keep track of all 500 points of information for each provider. With electronic versions of all records automatically filed, securely stored and easily accessible in a centralized location, you can minimize the chances of a negligent credentialing case. If a suit is brought forth, you have valid documentation as defense to prove you followed the exact procedures and steps, correctly and consistently.
Moreover, automated alerts and emails can notify designated parties—both administrators and providers—when information needs to be added or updated. For ASCs with large staff sizes and numerous items to track for hundreds of providers, these systems offer color-coded reports that easily show if any information is expiring, expired or missing, simplifying the process immensely and preventing possible enrollment delays.
A spreadsheet does not provide the same benefits. Excel will not alert administrators to expiring, expired or missing information. Moreover, credentialing is something that needs constant monitoring. If an administrator is out of the office and something expires, traditionally, the issue would not be handled until they return. The problem is some insurance payers specify that responses must be submitted within 72 hours or a provider will be terminated. This can lead to challenges with patient care and make a practice vulnerable to potential litigation throughout the appeals process.
In the end, with a proper management system, your ASC is in a much better position to provide a solid defense against negligent credentialing. Credentialing management systems not only help you build in negligent credentialing safeguards, but also are designed to cut down the time it takes to complete applications, provide consistency of process, and maintain up-to-date credentialing of all providers on staff. These systems help protect your ASC from liability issues so that you can keep your focus on delivering quality patient care.Read the full article from ASCA 2020 to learn how to avoid negligent credentialing.