Healthcare Operations



How automating credentialing can aid patient care, bring efficiency

Mitigating healthcare credentialing burdens and mistakes can provide additional patient safety and improve care quality.

Most people are familiar with the saying, “If anything can go wrong, it will,” and there are times when this saying comes true more often than we’d like. This is especially true when something goes wrong in the workplace. When it comes to credentialing issues in healthcare, mistakes that occur during the credentialing or recredentialing of a provider at a facility will impact more than just the bottom line.

Healthcare credentialing is the process of verifying that a provider is who they say they are and qualified to deliver medical services. Although time-consuming and complex, credentialing is legally required and plays a crucial role in enabling healthcare organizations to deliver on their commitment to provide high-quality patient care.

Medical staff professionals, responsible for provider credentialing, may spend weeks and even months gathering massive provider data to meet accreditation standards and avoid costly mistakes.

In every health system, there are hundreds – and, in some cases, thousands – of providers. There are not enough hours in the day to manually collect the needed information and documentation for each provider, let alone begin the actual credentialing process. Without automation to ease data collection, managing the process is nearly impossible.  

Financial and reputational repercussions

Successful credentialing requires a meticulous process. When the process breaks down, costs add up. Fixing a credentialing mistake requires time to investigate the error, paying fees for the repetitive work that’s necessary, and labor costs to fix the error. This can result in delays, which could cause forfeited reimbursements from payers that, on a case-by-case basis, can add up to hundreds or thousands of dollars.

According to a study by Merritt Hawkins, the average physician earns a facility about $2.3 million per year, so when a provider is bogged down in the credentialing process, this can cost an organization an estimated $9,000 per provider per day in delayed or lost revenue. Even worse, mismanaged credentialing can lead to patient leakage, harm or death if treatment is not scheduled or delayed, resulting in expensive lawsuits related to negligent medical credentialing, as well as lingering effects on a health system’s finances and reputation.

The impact on patients

Ensuring providers have the necessary credentials and clinical experience to be granted privileges at a facility is an important process that can be difficult to accomplish. Imagine a provider performing a surgical procedure on you that he or she has only done once. Knowing which providers have the qualifications to do specific procedures in a facility is critical, because a mistake in granting privileges could lead to patient injury or worse.

Creating and maintaining privilege delineation forms that comply with changing industry standards and regulations can be a daunting, labor-intensive process that requires collaboration and extensive ongoing research across many specialties. However, to ensure patient safety, clinician satisfaction and to set the revenue cycle in motion, it’s critical for providers to be credentialed and privileged quickly and accurately. 

An enhanced privileging process for practitioners and medical staff services professionals is a must for patient safety and to kickstart the revenue cycle. By leveraging integration and credentialing technology to connect health systems’ processes end-to-end – from privilege applications and provider profiles to consumer lookups – healthcare organizations can save time, money and realize full end-to-end electronic privileging.

Increase clinician satisfaction

The credentialing and recredentialing process is a tedious and laborious administrative task for providers. They can spend hours, if not days, completing forms, scanning source documents and attesting to questions. This takes time away from seeing patients, which equates to loss of income for the healthcare organization and increases the likelihood of provider burnout.

Additionally, for medical staff professionals, an inefficient process can lead to credentialing mistakes, which can negatively affect morale. Medical staff professionals expect their organizations to have solid processes that meet the highest possible quality standards.

By having documented policies and procedures and a quality assurance program in place that is focused on identifying mistakes before they become costly, hospitals and health systems can create a successful scenario for everyone, including physicians, staff, patients and the organization as a whole. 

Credentialing mistakes will happen, but there are ways to proactively minimize them. By utilizing provider credentialing and privileging software to automate the process, a health system’s medical staff services department can streamline the entire provider lifecycle, from initial application to performance monitoring. 

Automated credentialing technology makes data gathering, secure access, reporting and ongoing compliance less burdensome for providers, credentialing staff, and internal approval committees. With such technology, hospitals have reported a 20 percent reduction in credentialing timelines, including a 50 percent reduction in committee review meetings. 

Managing the process effectively becomes easier using the right software to help an organization’s team ensure that all facets of physician credentialing are verified and to provide notifications when a provider’s licenses or certificates are due to expire. Additionally, having a privileging system tied to credentialing will ensure providers are vetted with the appropriate training, experience and clinical competencies that they need, minimizing harm to patients and associated risks.

Patrick Birmingham is executive vice president of credentialing operations for symplr.

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