Learning
Credentialing
Compliance
Dotting your i’s and crossing your t’s is always critical in provider credentialing, but it’s even more so when you know you’ll face an HRSA operational site visit or OSV. Known for requiring a high level of documentation, OSVs add additional pressure and unique protocols regarding HRSA credentialing.
Not to mention, HRSA-funded organizations typically have a wide range of provider types, which means differing processes, requirements, and documentation. Keeping these straight in a very fast-paced healthcare environment is tough!
In this blog, we’ll look at the unique aspects of HRSA credentialing requirements and why many community health centers, FQHCs, and look-alikes use credentialing software to prepare for a successful on-site visit.
What Are HRSA Operational Site Visits?
The Health Resources and Services Administration (HRSA) provides millions of Americans with quality, affordable healthcare and other services via 90-plus programs and more than 3,000 grantees. HRSA programs cater to geographically isolated, economically challenged, and medically vulnerable populations.
HRSA conducts Operational Site Visits (OSVs) to evaluate how health centers and look-alikes comply with statutory and regulatory requirements in all operational areas (fiscal, clinical, administration). These visits cover everything from clinical staffing and billing to board composition, budget, and the organization’s needs assessment. OSVs are conducted at least once per performance period, one year or three years.
The health center must submit the required documents at least two weeks before the start of the site visit. The visit usually lasts three days, during which the surveyor will meet with center leaders and board members to gather information and assess compliance.
Credentialing Requirements for the HRSA OSV
HRSA splits required documentation between two categories: licensed independent practitioner (LIP) and other licensed or certified practitioner (OLCP) and clinical staff. The table below outlines some required credentialing documents by practitioner type from the Bureau of Primary Health Care.
| Credentialing Activity | LIP | OLCP; Other Clinical Staff |
| Verification of identity (for initial credentialing) |
Government-issued picture identification. | Government-issued picture identification. |
| Verification of current licensure, registration, or certification | Primary source verification (PSV) directly from the state licensing agency/body. | Primary source verification (PSV) directly from the state licensing or certification agency/body.
Not applicable (N/A) for other clinical staff in states, territories, or jurisdictions that do not require licensure or certification for other clinical staff. |
| Verification of education and training| (for initial credentialing) |
PSV required. Graduation verification from medical, dental, or other clinical professional school and any residency, including receipt of sealed transcripts. | For OLCPs and other clinical staff, the health center determines the process for verifying education and training. |
| National Practitioner Data Bank (NPDB) Query | Copy of completed report from NPDB query or documentation that the health center is signed up for continuous query from the NPDB. | Copy of completed report from NPDB query or documentation that the health center is signed up for continuous query from the NPDB. |
| Verification of Drug Enforcement Administration (DEA) registration (if applicable) | If applicable, copy the physician’s/provider’s current DEA registration certificate, indicating the issue and expiration dates. | Same as LIPs. Only applies to any OLCPs authorized to dispense controlled substances by the state they practice. |
| Verification of basic life support training | Documentation of completion of basic life support training (for example, a copy of the certificate of completion, course completion dates) or training documentation included as part of provider licensure or certification. | Documentation of completion of basic life support training (for example, a copy of the certificate of training and course completion dates). |
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Solving Common HRSA Credentialing Challenges With Software
Community health centers move quickly, seeing a high volume of patients. Any challenges encountered in the credentialing process can significantly impact financially and on the community the organization serves.
Credentialing software improves staff efficiency and accuracy and provides a way to manage the volume of required documentation — all of which makes it easier to meet HRSA credentialing requirements.
Here’s a look at some of the ways credentialing software solves common challenges:
Provider Data Management
Credentialing is time-consuming and tedious, with dozens of requirement documents and hundreds of data points for each provider. Credentialing software puts all that information into a provider profile to easily maintain accurate and up-to-date provider information. The top software even includes completion percentages so credentials know a glance if additional information is needed. Leading credentialing software offers a secure online portal for providers to upload the documents required by HRSA and automated email reminders that continue until completed.
Automation
Another time-consuming process is verifying the extensive documentation required for each provider, including education, licensure, certifications, work history, and malpractice insurance. By automating these tedious tasks, such as exclusions monitoring and license verification, you can eliminate the website hopping and waiting — again, freeing up valuable time for credentialers to spend on the tasks that require a human touch. You can also automate reminders to stay on top of important deadlines, like re-credentialing and expiration.
Workflows
Delays in the credentialing process can impact patient care and revenue cycle management. 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 HRSA credentialing 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 HRSA program 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, HRSA organizations can enhance efficiency, reduce errors, and maintain compliance, ultimately improving patient care and operational effectiveness.
The Future of HRSA Credentialing
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 programs looking to advance their HRSA 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.