Edition 2: Is Your Hospital Making These Critical Credentialing Mistakes?

At MedicalLicensing.com, our mission is to help healthcare providers ease their licensing, credentialing, and payer enrollment processes. So, if you have any questions or concerns about the licensing and credentialing process, don't hesitate to reach out to us.

In Edition 1, we've explored the Interstate Medical Licensure Compact, providing key insights into eligibility requirements and tips to avoid common pitfalls. This time, let’s talk about:

Hospital Credentialing Errors & How to Avoid Them

It is crucial for healthcare professionals to ensure high-quality data accuracy and precision to deliver consistent quality healthcare. With zero room for error in diagnosis or treatment and no provisions for increased healthcare costs without proper rationale, credentialing is essential to ensure quality healthcare delivery. Credentialing errors in hospitals can be frustrating and costly for providers and healthcare facilities, causing significant onboarding delays.

Just imagine the frustration of recruiting a top-notch provider for a critical role at your facility, only to have their start delayed due to a credentialing error.

To avoid these costly errors, it is essential to have a streamlined credentialing process in place, which can save time and increase accuracy. As medical licensing and credentialing experts, we have seen it all and can help you avoid these common errors, ensuring your providers can start seeing patients as quickly as possible.

The Hidden Risks of Hospital Credentialing

Credentialing is a complex process that involves various factors, making it prone to errors. Lack of information, negligence, oversight of important aspects, inadequate expertise, and the absence of healthcare automation can lead to missing critical information needed for decision-making by credentialing authorities. In addition to filling out application forms, credentialing requires supporting documentation, which can be challenging to manage in a manual process involving paper documents. This can increase the risk of errors and omissions, especially when dealing with a large number of medical staff.

Time-Consuming Hassles

The credentialing process can take several months, requiring additional data and information collection, and multiple rounds of communication.

This can lead to an excessive amount of paperwork, delays, and unique challenges, such as the need for qualified resources to pre-verify the paperwork, signatories for relevant documents, or verification stamps and seals from relevant medical regulatory authorities.

Insufficient Time Allowance

Not allowing enough time for credentialing or underestimating the time required is a common mistake that can lead to delays and potential errors.

Some changes in medical care practices may require re-credentialing, which adds to the timeline, making it crucial to factor in additional time for such contingencies.

Precision of Data

Data accuracy is a crucial aspect of credentialing that cannot be overlooked. Inaccurate information may lead to rejection of the application, necessitating initiating a new credentialing request, further delays, and the possibility of the contract between the healthcare provider and insurer being canceled.

As insurers become more stringent about healthcare quality, even small mistakes can lead to healthcare providers being delisted from insurers' preferred provider networks.

Credentialing Issues and Liability Concerns

Properly credentialing healthcare providers is a crucial process that cannot be overlooked. It demonstrates that a hospital has thoroughly vetted a provider before allowing them to care for patients. Credentialing errors that may lead to legal issues include:

• Allowing a physician to treat patients before their credentials are verified. If a physician falsifies their credentials, hospitals can be held liable by courts.
• Neglecting to update and verify the information. Healthcare practitioners must renew their licenses and credentials regularly according to state laws. Initial credentialing and re-credentialing every three years ensure that healthcare personnel is up-to-date with their board certifications and licenses.
• Concealing previous adverse actions. Failing to disclose prior disciplinary actions is a serious mistake made by any physician, and it is also the responsibility of healthcare organizations to perform background checks to identify such issues.
• Not taking peer review activity seriously. Information provided in a peer review or investigation should be taken seriously and carefully evaluated as part of the credentialing process. Peer references can provide valuable insights into a physician's abilities and competencies.
• Neglecting to report adverse actions. Physicians are required to report adverse actions such as license revocation, exclusion from third-party programs, and suspension or voluntary relinquishment of medical staff membership, clinical privileges, or state or federal DEA licenses.

In cases where a physician has withheld adverse actions, the hospital, and health systems will be held accountable for the physician's omission.?

The National Practitioner Data Bank (NPDB) requires reporting of the following actions:

• Medical malpractice payments
• Federal and state licensure and certification actions
• Adverse clinical privileges actions
• Adverse professional society membership actions
• Negative actions or findings by private insurance entities

If any of these actions occur, it's vital to report them promptly and accurately. Failure to do so can lead to significant legal and financial consequences.

Credentialing errors often occur due to a lack of systemization and robustness in the credentialing process, leading to inefficient work practices and workflows. This can result in delays and a loss of trust in the credentialing process among medical professionals and candidates.

The best way to prevent such errors is to use intelligent automation, which keeps track of all documents collected, disbursed, and verified.

Don't Let Credentialing Mistakes Cost You

Prevention is the best way to troubleshoot credentialing mistakes, and many errors can be avoided by using automation. Outdated contact information, for example, is responsible for over 85% of rejected applications. Retraining staff can also help, ensuring accuracy, attention to detail, and patience in troubleshooting. Reactive troubleshooting, which involves re-verifying all records, is laborious and prone to creating manual errors, but it can still be useful for retraining staff on critical knowledge aspects.

The most effective way to troubleshoot credentialing mistakes is to prevent them altogether, and automation is key to achieving this.

Medical billing and credentialing software can provide on-the-fly verification, suggestions, and auto-fills, while integrated solutions can reuse data from other systems, saving time and ensuring applications are submitted on time without errors.

Proper credentialing is critical for the success of any healthcare organization. With the potential for legal and financial consequences, it's essential to have a streamlined and accurate credentialing process in place.

As healthcare credentialing experts, we understand the complexities and challenges involved in the credentialing process. Check out our comprehensive guides that will help you avoid the common credentialing mistakes, saving time, money, and valuable providers:

• Why Accurate Provider Data is the Key to Stellar Healthcare & Compliance
• Credentialing 101: Unveiling the Importance for Healthcare Providers
• Provider Enrollment & Credentialing Timeframes: A Comprehensive Guide
• Are You Overlooking Provider Data Maintenance in Credentialing & Enrollment?

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To get even more insights:

• Visit our blogs: MedicalLicensing & Credsy, where we publish step-by-step guides, valuable insights, and helpful resources.
• Follow Credsy LinkedIn page.

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