It’s no secret that physician credentialing is critical, involves risk, and is time-consuming. In fact, credentialing is one of the most necessary processes in healthcare to protect patients, providers, and healthcare organizations. Physicians can’t practice medicine or get paid if they aren’t properly credentialed, yet many healthcare organizations still haven’t updated their process. 

So what are some of the risks if your practice still hasn’t upgraded how you credential physicians? Consider these:

1. Healthcare organizations spend approximately $39,000,000,000 billion annually on administrative tasks for regulatory compliance.

Why this matters: Protect your practice’s cash flow. Money is literally being thrown away as a result of inefficient credentialing processes. The good news? This cost can be significantly reduced by optimizing your credentialing process.

2. Medicare uncovered $26 million in erroneous payments tied to expired or fake provider credentials.

Why this matters: When new prescriptions come into specialty pharmacies, they go through a very slow prescriber credential verification process that can involve manually calling or looking up licenses for the prescribing physicians on various board websites. When refills arrive, the pharmacies usually don’t verify prescriber licenses at all. This means that patients are sometimes getting drugs from unlicensed prescribers and/or are being kept waiting for life-saving medications because of slow, manual verification, which also lets through a lot of fraud and abuse. The Centers for Medicare & Medicaid Services (CMS) has been accelerating what is called “clawbacks” requiring medical organizations to return payments they made for earlier services. Pre-dispense verification technology can easily fix this problem and help organizations avoid hefty fines. 

3. Forty percent of credentialing information found on your providers’ roster is incorrect.

Why this matters: That incorrect information causes 85 percent of provider credentialing applications to have missing critical information. This leads to wasted time and delayed payments. Are you keeping your team of providers in compliance and maintaining your providers’ data accurately?

4. Your healthcare organization must comply with 629 regulatory agencies in order to keep providers properly licensed.

Why this matters: Excel sheets can’t manage this, yet that is what most organizations rely on. It’s exhausting and error-prone. Save some time for bigger problems. Digitizing your process can help better manage this, and credentialing software solutions don’t have to break the bank. The time saved and fines avoided will be worth the investment.

5. Almost 17 percent of physicians’ working hours are spent on administrative tasks.

Why this matters: Physician burnout is real, leading to career dissatisfaction and taking time away from patient care. Updating internal credentialing processes can fix this. Less time spent credentialing means more time with patients.  Considering how difficult it is for patients to access care in today’s current healthcare climate, not to mention roadblocks like a national provider shortage and physician burnout, inefficient credentialing processes that create obstacles to care should and can be avoided. As we know, there is often no silver bullet to improve most of the challenges that prevent our healthcare system from functioning better. However, that’s not the case for credentialing, where a simple solution for improvement exists now. And technology holds the answer.

Innovation has greatly improved the credentialing process, making provider verification easier, quicker, more accurate, and safer. No more sticky notes, no more positions unfilled, no more delayed payments, no more physicians and patients left in the lurch due to oversights caused by chaotic credentialing practices that could have been prevented.

How are you protecting your practice?

Get started with Modio today.

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