10 Effective Tips for Successful Medical Staff Credentialing

If you are planning to hire a new doctor or establish your own practice, it is crucial to initiate the credentialing process ahead of time to prevent potential issues. Neglecting the importance of medical credentialing services could lead to delayed cash flow, challenges in scheduling due to patient restrictions, and frequent communication with insurance providers.

This article aims to list 10 effective tips for successful medical staff credentialing. Before getting into that topic, let us first understand the significance of credentialing.

What is meant by credentialing?

Provider credentialing is the process of confirming a physician’s attendance at a medical school and their possession of a state license. It also entails verifying their employment history and examining malpractice insurance carriers that are associated with them.

Additionally, credentialing requires conducting a background check on the provider's criminal and financial records, as well as a review of their social media background, which is becoming increasingly important. The references provided by the physician will also be checked. Since this is a complex procedure that often takes longer than anticipated, it is crucial to start preparing early. Here are ten helpful tips to ensure a successful provider credentialing process.

1. Connect with a medical staff credentialing partner

If you intend to delegate credentialing responsibilities, it is important to engage with a medical credentialing service such as ProLocums to effectively manage deadlines and expiration dates. By receiving timely reminders, you can guarantee that no one's credentials lapse, preventing any denials of reimbursements.

2. Make sure to allocate sufficient time for the credentialing procedure

It is recommended to budget around 150 days for the credentialing process, although it is expected to take approximately 90 days. It is important to be aware that each payer has its own timeline for credentialing. By assuming a longer time frame, you can ensure that you are prepared for the process, and if it takes less time, it will be a pleasant surprise.

3. Keep informed about the credentialing program offered by the Coalition for Affordable Quality Healthcare (CAQH)

Payers are widely embracing the Coalition for Affordable Quality Healthcare (CAQH) uniform credentialing program. Physicians who consistently update and verify their information through CAQH experience smoother and more effective credentialing and re-credentialing processes, making it highly beneficial to engage with this program.

4. Link the start date of a new provider to the submission of their credentialing forms

Some practices require credentialing paperwork to be submitted immediately after extending an employment offer, while others tie the starting date of a new physician to the submission of paperwork. For instance, you could set the starting date no earlier than 120 days from the receipt of their credentialing information.

5. Develop a credentialing process that is sustainable

Establishing a credentialing workflow may pose difficulties, but it proves beneficial in the long run. Regardless of whether the credentialing process is outsourced, your workflow must ensure the retention of all necessary forms and documents. In a practice with multiple physicians, re-credentialing constantly arises, making it highly advantageous to have a workflow that can effectively handle this task.

6. Do not make the assumption that all payers permit billing a new physician as locum tenens.

You have the option to bill a new physician as locum tenens with certain payers if their credentials are not yet complete. However, not all payers allow this practice. It is advisable to complete the physician's credentialing process in order to bill normally. If that is not possible, it is recommended to contact the payers to determine their policy on locum tenens billing.

7. Ensure that you regularly update all contact information for physicians

Ensure that your credentialing coordinator keeps accurate and current contact information for all physicians. It is crucial to have direct contact in order to efficiently handle any credentialing or re-credentialing matters. Additionally, the credentialing process requires submitting multiple forms, and it is vital to maintain clear communication throughout.

8. Ensure that every physician has a clear understanding of the obligations and expectations placed upon them.

It is essential for every provider to be aware of their obligations regarding credentialing or re-credentialing. Upon extending a job offer, it is important to clearly communicate to the new employee the specific information required, such as their work and education history, certification and license details, as well as malpractice liability certification, among other necessary documents.

9. Perform a personal background check at the outset

Numerous practices opt to perform independent background checks on prospective physicians, ensuring their training, licensure, and employment records are accurate before extending a job offer. While it may seem excessive, this precautionary measure effectively prevents any potential complications stemming from licensing issues after hiring.

10. Gain a complete understanding of the regulations in your state

Physician credentialing laws may vary by state, and some states may have reciprocity agreements with payers and other credentialing organizations from different states. If a physician is already credentialed with a payer in another state and plans to join your practice, the payer may expedite the credentialing process for their new position.

Final Thoughts

Having a clear understanding of credentialing processes can greatly improve the efficiency of practice and accelerate cash flow. Issues with medical credentialing services can be costly and hinder productivity, highlighting the need for a well-established procedure to ensure credentials are always up to date. To ensure you experience a seamless credentialing process, connect with ProLocums.

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