Provider credentialing is a necessary evil. We say evil, but it’s clearly not all bad since it literally puts money in your pocket. But when you’re elbow-deep in forms and deadlines, it can feel like a nightmare. Because the process of credentialing is so long, any small error can lead to more time and more work. The process of provider credentialing includes license verification, document tracking, internal privileging, continuing education, and provider enrollments. All important pieces that are vital to ensuring your healthcare providers are proficient.
Here are a few ways to prevent errors in provider credentialing so you can get to more important things like patient care.
Working with outdated provider information
The entire purpose of provider credentialing is to verify a provider’s qualifications. One of the first steps in credentialing is gathering current provider information. Healthcare practitioners are responsible for providing that information, but it is the employer’s responsibility to double-check to make sure it is up to date and accurate. This can be a tedious process depending on how many providers you have, but it is crucial. Even if a provider has been credentialed and recredentialed, you still need to verify their information is up to date.
Working with outdated provider information is like trying to ride a bike without wheels. You’re not going to get very far.
Missing primary source verification information
To determine whether provider information is accurate, we rely on primary source verification which is just what it sounds like. If the provider says they graduated from a certain university, reach out to the university, the primary source, to verify. Unfortunately, this can be challenging for a variety of reasons. Universities are pretty busy it turns out. Sometimes the provider doesn’t have up-to-date contact information and before you know it, the application is due so what do you do? Send it in without primary source verification.
This can lead to a variety of issues like delaying the start date for a provider or creating issues in the enrollment process for payers. If your enrollment application is considered incomplete, it can extend the length of the process. Here’s a mantra for you: Don’t give payers a reason to reject your application, get those attestations!
So far we’ve discussed gathering and verifying provider information which already feels like it’s going to take quite some time. This leads us to our next common error in provider credentialing: Time Management. The recommended time to plan for credentialing? Several months before your provider is scheduled to start. Credentialing is susceptible to Murphy’s Law which states, “Anything that can go wrong will go wrong.” The best way to avoid this is to make sure you have ample time. Covid-19 taught us how quickly things can change and how long things can be delayed. Don’t wait until the last minute to ask providers for verification information. Build-in time to follow up. Emergencies happen and if you build in time for delays, you’ll always make your deadlines.
Data entry errors
Have you heard of the 20-20-20 rule? When working at a computer, every 20 minutes look at something 20 feet away for 20 seconds. This is to prevent eye strain. Eye strain can lead to blurred vision, headaches, and difficulty concentrating which can lead to data entry errors. For some people, a few data errors aren’t the end of the world. But when you’re gathering hundreds to thousands of data points, a couple of errors can turn out to be costly to the provider and your organization.
In this case, self-care isn’t just for yourself. With planning and proper time management on your side, you can afford to take breaks and stay fresh when reviewing important documents for your own good and for the good of your organization.
Lack of follow up
In a perfect world, all of your providers would have up-to-date information and would send you the necessary documents you requested ASAP. But part of what makes credentialing such a long and stressful process is always having to be on top of it. Creating a list of documents needed from providers and beginning the steps of primary source verification can give you a false sense of security. But requesting documents and verifications without following up is like throwing a bottle in the ocean and hoping it reaches someone. Small questions or errors in credentialing documents and enrollment applications can lead to rejections or having to repeat your work. By following up you ensure everything gets done accurately and in a timely manner so that your providers can start treating patients and getting paid. Persistence pays off in credentialing.
Whether you’re outsourcing your credentialing duties or have an in-house credentialing team, technology is here to help. Not all technology is created equally and when dealing with sensitive documents, it’s important to think about privacy and efficiency. Excel sheets are great but they weren’t designed to handle the demands of credentialing and enrollment applications. There are credentialing-specific platforms that are built for the storage and management of provider documents, have built-in reminders for when licenses and recredentialing are due, as well as keep a record of changes made to documents by staff.
Learning and implementing new technology can seem overwhelming, but when you think about everything you already have to keep track of for credentialing, having an expert on your side would be the icing on the cake.
The next time you’re preparing for credentialing, remember: plan accordingly, have up-to-date information, gather attestations, rest, but be persistent, and have technology work for you.
Remember, there is literally money on the table. Get yours!
MedTrainer helps your facility manage your credentialing workload by providing you with the tools to succeed and save time. Learn more about MedTrainer’s expert credentialing platform today.