December 2, 2022
Irrespective of the industry, demand and challenges are the most common factors. If we talk about the healthcare industry, the main goal is to make sure to meet standards to deliver quality care to patients. In this industry, chances of errors are minimal because patients' health is on the line. This is the reason why credentialing is essential.
It is a quality assertion process designed to minimize medical errors. With the help of this process, organizations get to know everything about the doctor, such as educational background, license, previous experience, training, and much more. This practice is conducted before getting hired at a medical facility.
It provides patients peace of mind that they are being treated by professionals. For practices, it ensures that the employed staff will deliver the highest quality of services and keeps them safe from any lawsuits and liabilities. It also benefits insurance companies as having a professional practitioner on their panel helps them in reducing care costs.
Provider credentialing includes verification of qualifications, license, and career background.
The first step in the credentialing process is completing the application and all the required documentation. After that, the individual will wait for the primary source verification and clarifications. The last step is to get enrolled and update the billing process with the new insurance company.
This whole process is full of hassles as it involves a lot of paperwork and requires ultimate accuracy. Practitioners need to meet critical deadlines, meet compliance standards; failing to do so will result in a considerable loss of capital. Moreover, it is also a time taking process, so the right strategy is to implement a practice management system and avoid the following common mistakes, as failure to do so will jeopardize the whole process.
The complete credentialing process typically takes more than three months as it consists of the verification of a lot of data. Gathering all the required documents for a successful application may take a bit more time than expected. Mostly, this time delay surprises the staff at the facility, resulting in affecting both the provider and practice equally.
Practitioners need to wait longer to start giving consultations, whereas healthcare practices need to bear the loss of revenue because the insurance providers will not reimburse the bills of a new doctor unless it gets credentialed and enrolled. These issues can be solved by employing best practice management solutions.
The application must be accurate and contain all the required details so there will be no reason for delay or denial in credentialing. The most common data entry mistakes are as follows:
Applications are often marked as incomplete if the required information is not added correctly or failed to attach supporting documents. It is mandatory to add all the documents showing the doctor's complete history. Improper authorizations are one of the critical errors in the application process. Lacking the necessary signature and attestation results in rejection.
Every state has its own requirement for credentialing, and failure to comply with these standards will result in compliance failure. In several cases, the ignorance of staff messes up everything, so make sure to get it done with the help of professionals. Each insurance company is different; the same goes for their credentialing and enrollment process. Practitioners need to the complaint with their specifications as failing to do so will result in a delayed payment process.
The enrollment process has a direct connection with the billing and payment process. Due to this, practices can't afford any errors as they will negatively impact the revenue cycle. To enjoy a stable revenue cycle, the first thing is to make sure that the application must be as per the insurance provider's criteria. For this, they need to follow the protocols and regulations so that there will be no credentialing mistakes.
In this article, we have briefly discussed some of the common mistakes healthcare providers make during the credentialing process. We have shed light on mistakes in enrolling process, compliance errors, issues with the application process, data entry mistakes, and much more. Moreover, we have also explained how talkEHR's practice management software will help practices meet their revenue goals.