The Top 6 Credentialing Challenges in Healthcare

Sarah Jones
A female healthcare professional sits at a desk with a computer. She is typing on the keyboard and is wearing glasses. She is wearing a white lab coat.

Making sure you’ve hired the right people for the job is essential to every business. Not having qualified employees puts service capabilities, productivity, and other aspects of the company at risk. This is especially true when it comes to the top six credentialing challenges in the healthcare industry.

Why Credentialing Is So Crucial 

Credentialing is the process of verifying that a healthcare provider’s documentation, certifications, and background are legitimate. It is incredibly important to ensure physicians are qualified for the job in order to provide safe and ethical patient care, along with protecting the healthcare institution itself.

For example, if your hospital grants privileges to someone who doesn’t have enough experience, the resulting damage can lead to costly negligence lawsuits — and no healthcare organization wants to deal with that.

However, as integral as the medical credentialing process is for hospitals, it is by no means an easy task. There are numerous problems that healthcare organizations can encounter that make credentialing a pain to deal with. This is especially true when they are understaffed and need to bring on more providers to alleviate stressful conditions. To prepare your establishment in advance, learn six of the most common credentialing issues in the industry.

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1. Starting Providers Before Their Credential Verification

As the purpose of healthcare credentialing is to ensure that a care provider has the right qualifications for their position, letting them start prior to the completion of their credential verification can lead to multiple problems. Overworked hospitals may feel tempted to grant a new provider their privileges as soon as possible, but by doing so, they may be placing the care of their patients in the hands of someone who is not qualified.

In addition to ensuring a practitioner has the necessary experience, hospitals must wait for other sources to be verified. Without performing thorough background checks, a healthcare facility may accidentally bring on an individual that has been debarred. For that reason, the credentialing board must not ignore peer references either, as they can reveal details about a provider that their education and training background may not.

2. Failure to Recredential Current Providers

Even if a healthcare provider has been credentialed once, that won’t be their last time. Recredentialing is also important, as credentialing laws can change over time. A provider may no longer meet the qualifications of a given state if regulations change, which may result in malpractice cases. Therefore, they must be updated regularly to meet the requirements of the state they are practicing in.

Furthermore, while OIG and SAM exclusion checks should always be performed prior to hiring a provider, they should also be performed regularly throughout the year. The Office of Inspector General produces an exclusions list called the OIG Excluded Individuals/Entities, or OIG-LEIE. Hiring someone from this list means you are hiring someone who has committed fraud, waste, or abuse in the healthcare system, inevitably putting your organization at significant risk for unethical liability, lawsuits, and hefty fines.

The System for Award Management (SAM) is another exclusionary list that must be checked prior to hiring an individual. An excluded party is any individual that has been debarred or suspended from doing business involving federal funds. Again, should this verification be missed prior to hiring an individual or during the recredentialing process, your organization is a risk.

3. The Application Is Incomplete or Incorrect

There is an immense amount of information that healthcare providers must submit for their credentialing applications, and as a result, they may accidentally leave some information blank. Any incomplete applications will cause delays in the credentialing process and possibly even result in denied claims, further hindering an already lengthy process. Always double check to ensure everything has been filled out!

Although an applicant may not leave anything blank, there’s no guarantee that all of it is correct. For example, they may write down incorrect contact information if they’ve recently moved. While this mistake may not be too serious, other errors, such as an out-of-date license, can be more severe.

4. Labor Issues

Healthcare credentialing is a time-consuming process. With countless physicians to keep track of, it can be very difficult if there are not enough staff members or resources allocated to the task. However, even if there are enough people on the credentialing team, the amount of work that must be done can still become incredibly stressful. As credentialing requires attention to detail to avoid errors, accumulated stress can result in mistakes that will cost a healthcare organization time and money.

Contributing to credentialing specialists’ increased workload is high staff turnover. With so many nurses and physicians coming and going, the stacks of paperwork can quickly become too much to handle. The more paperwork there is, the more tasks there are, and the longer the delays will be before providers can start seeing patients. By streamlining the credentialing process including Primary Source Verification (PSV), you’re saving time and making more money, sooner.

5. An Inability to Properly Manage Time

Given how long healthcare credentialing can take for a single provider, failing to meet deadlines can further stall the process. Poor time management can prevent a busy hospital from adding the new healthcare providers to its staff, resulting in lost revenue and staffing shortages — it is imperative for the facility to manage its time appropriately.

Some of the things that can harm a facility’s time management are setting a start date for a provider before their credentials have been verified. It takes time to exchange correspondence with insurance companies and primary sources, so factoring these timeframes into your credentialing process is essential.

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6. Staying Up-To-Date With Credentialing Requirements

Lastly, a major hurdle hospitals must overcome during healthcare credentialing is the ever-changing requirements within the healthcare industry. As requirements grow stricter and more specific, credentialing teams must stay up-to-date with contemporary regulations. Additionally, it is imperative for staff to take state requirements into account, as they often differ based on location.

Use MedTrainer to Resolve Credentialing Problems

Many of the credentialing challenges in healthcare can be addressed by transitioning your hospital to digital software, which will eliminate human error, streamline the process, and provide other benefits as well. From automated OIG-LEIE and SAM checks, PSV, and recredentialing tasks, MedTrainer’s software can solve the many credentialing issues your healthcare organization may encounter!

In addition to healthcare credentialing, MedTrainer also provides user-friendly reporting features so you know exactly where everyone stands with credentialing, training, and compliance, in real-time. For more information on MedTrainer or to schedule a demo, reach out today!