'Tis the Season for Healthcare Credentialing To Slow Down

It seems hard to believe that healthcare credentialing could take even longer, but unfortunately there are two times of year where that is exactly what happens.

In my experience — working for both payers and health systems — the time to complete credentialing is the slowest in December, with the summer months being a close second. We call it the winter lull and summer surge.

In December you might want to plan for an extra 30 days to complete payer enrollments.

Impacts of a Longer Credentialing Process

The pressure can really mount when credentialing takes so long and you know the organization’s revenue cycle will be impacted. When education can’t be verified because universities are closed in December or enrollment applications sit for weeks during the summer surge of recent graduates, provider start dates have to be delayed.

It’s estimated that every day a provider can’t practice, the healthcare organization loses $10,000 per provider. It can add up fast. And at the end of the year, this potential revenue loss is compounded by current providers who inadvertently let certifications lapse. According to a Crowe RCA Benchmarking Analysis, hospital revenue takes a dip in the first quarter with an increase in initial claim denials. This could be a result of issues credentialers were dealing with in December.

Why Does the Credentialing Slow Down in December?

It’s understandable why credentialing slows during the summer months — it’s a combination of an influx of new providers and summer vacations. But, when credentialing slows down in December, there are additional circumstances that both providers and credentialers will need to plan for.

1. Employees have to use time off or lose it.

Most commercial payers have a “use it or lose it” time off policy, meaning that any paid time off that is not used by December 31 is forfeited. As a result, there are a lot of employees off at any given time. When I worked for one of the nation’s largest payers, I can remember seeing entire empty floors at the office in December. Government payers often have plenty of paid holidays in December that keep them out of the office.

It’s not just the payers. Let’s say you take a week off and then the following week your contact at a payer is off and suddenly you’ve lost two weeks. And don’t forget the providers who have worked so hard all year and are now enjoying time with family and not responding to requests for documents or information.

2. Influx of December graduates to credential.

While more students graduate in May than December, there are still a large number of medical school graduates entering the professional world who need to get licenses and be credentialed. The difference in December is that most universities are closed for weeks during December, which makes educational verification difficult — if not impossible. If you don’t catch these employees prior to December 20, you’ll likely be waiting until the first few days of January. Often new grads often want to take three to four weeks off, so go ahead and encourage them to enjoy and give them a heads up that they might not be eligible to practice until February.

3. Certifications and insurance expire on December 31.

While most professional license expirations have started staggering expiration, many board certifications have not. Which means there are still a large number that expire on December 31. Most professional liability insurance also expires December 31. Probably we all have a horror story of a provider who didn’t read the many emails we sent in early December and went on vacation through the end of the year, only to return and be unable to be reimbursed for early January appointments and procedures. With providers and credentialers all over the country scrambling to meet these deadlines, the volume can cause a credentialing slow down.

Prepare Early To Avoid the Slow Down

It’s up to credentialing teams to be ready for the winter lull and summer surge. Here are few ways to avoid the negative impacts of this seasonality.

Set early reminders. When a provider has certifications, licenses, or insurance expiring on December 31, set the reminders for a month earlier than you typically would to give the provider extra time.
Give providers early deadlines. Give providers a November deadline so you can be sure you have all the information you need prior to offices starting to close for the holidays.
Set realistic expectations. Explain the early deadline to providers and the consequences of not submitting information and documents on time. They can enjoy the holidays knowing everything is on track.
Communicate with leadership. Be clear about the limitations you will face in December and offer projected start dates based on when documents are received from providers. You don’t want there to be any surprises in the spring!
Communicate with department staff. Let the departments know if you expect a credentialing slow down and offer expected start dates for new providers. You don’t want teams to have the provider scheduled, but not yet credentialed.
Use an enrollment checklist. Knowing that payers will be busy, make sure your applications have everything needed to avoid additional delays. If you don’t have an enrollment checklist, use your free time around the holidays to create one. Or find credentialing software that includes this feature.

While healthcare is an industry that is “always going,” there is definitely a credentialing slow down in December. And in the summer months, you can count on a surge. With preparation and communication, you can take control.

‘Tis the Season for Healthcare Credentialing To Slow Down