The sooner your credentialing issues are taken care of, the sooner you can focus on the day to day issues of serving patients and receiving timely payments. Ignore the significance of provider credentialing at your own risk - it is certainly one of the most important compliance issues that a medical practice encounters.
Here are some of the most common issues most offices will run into when it comes to provider credentialing.
Lack of Organization
You can always assign a coordinator to your credentialing process, whether you are outsourcing or doing in-house. This coordinator will keep the office on schedule, send out reminder texts and emails, and help to ensure that no credentialing expires. This will save the office money in appeals and lost reimbursements.
Lack of Timing
Your office will always have an issue if you expect to make your schedule work around the minimum time to process a credential. Although most carriers say they take around 3 months, the truth is often more like 5 to 6 months. Each payer has its own credentialing timeline, and most offices do not have the leverage or the time to challenge them. As a safety measure, assume the maximum amount of time no matter what. If it takes less time, then you will be ahead of schedule.
Physician Start Dates
A smart office will usually make a request for credentialing paperwork at the same time that an offer for employment is rendered. Other offices do not let a new doctor start working until that doctor submits paperwork for credentialing. As stated in the tip above, you may want to extend the start date of a physician to the maximum amount of time that the credentialing process might take. For instance, do not tell a doctor that she will start 90 days after paperwork submission - extend that date to 150 days.
Every office should commit the necessary resources to create a credentialing workflow. Although it may seem like overkill at first, it will save time and money in the long run. A workflow will help to normalize the documentation process, optimizing the time frame from submission to credentialing. A consistent workflow is likely to be less plagued by human error and the huge extensions this problem causes. A good workflow is especially important in a re-credentialing process, which usually occurs with a multi-physician practice.
Keeping Contact Info Up to Date
One of the most important responsibilities of your credentialing coordinator is to ensure all physician contact information is kept up to date. Re-credentialing can take an incredibly long time without direct contact information readily available. If there are multiple rounds of document submission required, having solid contact information will also speed up this process tremendously.
Private Background Checks
The credentialing process does not catch every kink in a physician's background, but payers will certainly use anything they can to deny a payment. Your practice should conduct its own background checks alongside the credentialing process. Verify all training, employment history and license before making any new offer to a physician. If this seems like too much now, remember that the process will pay for itself with the first collection problem that your practice avoids.
Depending on the state in which your practice does business, you may have additional credentialing requirements that are not fully covered by the process of another state. For instance, if you are considering a physician with a credential from another state, check on reciprocity agreements with the state and payer organizations. Understanding the laws of your state can make the credentialing process much easier, improving your cash flow and customer service applications. Do not let obscure state law become the reason that your office loses productivity.
If you have any questions about provider credentialing issue for your practice or how to maximize your reimbursement, contact us today for a free consultation at 770-666-0470 or email me at email@example.com.