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 credentialing requirements are contained in chapter three (clinical staffing) of the Site Visit Protocol (SVP). It is consistently one of the highest-risk chapters, and one of the most document-intensive. It covers whether you have enough of the right people to deliver your approved scope of services, and whether your credentialing and privileging processes are sound and current. You’ll need to provide written policies and procedures prior to the site visit, and while on site, the reviewer will pull a sample of individual provider files.
Provider documentation requests are split between three categories: licensed independent practitioner (LIP), other licensed or certified practitioner (OLCP), and other 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. | 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. |
Only if applicable |
| 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. | Health center determines the process for verifying education and training. | Health center determines the process for verifying education and training. |
| National Practitioner Data Bank (NPDB) Query | Copy of completed report from NPDB query (initial and every two years) or documentation that the health center is signed up for continuous query from the NPDB. | Copy of completed report from NPDB query (initial and every two years) or documentation that the health center is signed up for continuous query from the NPDB. | Not applicable |
| 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. | Not applicable |
| 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). | Documentation of completion of basic life support training (for example, a copy of the certificate of training and course completion dates). |
| Recredentialing | Must occur at least every two years | At documented intervals | Not applicable |
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Most Common HRSA Credentialing Documentation Missteps
Health centers usually have most of a provider’s credentialing file in order. It’s the small oversights or a lack of documentation that results in a HRSA OSV finding. An expired document that wasn’t re-verified, a privileging delineation form missing or unsigned, or a policy that says one thing while your files show another. Here’s what to watch out for when it comes to chapter three documentation:
- An expired BLS certification is the single most common finding across all staff categories
- Primary source verification not documented (be sure you’re tracking who checked, the date, and a trusted URL if online)
- NPDB query not performed or not on file for LIPs (capture a screenshot or use software that automatically tracks the query)
- Clearly defined privileging process that designates exactly what happens per privilege type and who approves privileges
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 have a significant financial impact on the center and on the community the organization serves.
Credentialing software improves staff efficiency and accuracy and provides a way to stay ahead of 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
Accurate provider data management is the foundation of HRSA credentialing. The best software brings all data into a single provider profile starting with a direct CAQH (now DataSpring) integration. All data in a single location enables enrollment and privileging forms to be automatically filled, and provides a way to quickly spot missing information. Leading credentialing software also stores provider documents in the same provider profile, with a secure online portal for providers to upload the documents or the option for credentialing staff to upload in bulk with AI-powered classification. All data in one place puts credentialing progress and status at a glance.
Automation
HRSA has very clear expectations around provider verification, a notoriously tedious back-and-forth process. Software can automate license and certification retrieval and track verification, all in the same provider profile already mentioned. Automated exclusions monitoring, license verification, and NPDB queries 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 expiration reminders, so you don’t find out malpractice insurance or a license is expired during your OSV.
Workflows
Delays in the credentialing process can impact patient care and revenue cycle management. Customizable workflows keep your HRSA credentialing process on track. For example, an end-to-end privileging process keeps things moving from automatic completion of the DOP form to board approval. You know exactly where everything stands and you eliminate the delays common in the process. Workflows may include a checklist with assignable tasks, reminders, and dashboards showing outstanding items and due dates.
Transparency
Without credentialing software, it is tough to be confident you have all the documents outlined in HRSA’s Site Visit Protocol. The best credentialing software tracks all documents, with the ability to flag in real-time anything that is missing. 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.