Let 2021 Be The Year You Finally Get Your Credentialing Process Right

Post-it Notes, paper folders, Excel spreadsheets, outdated software — these are tools the majority of practices use to manage their physician credentialing. Managing providers’ expirables and renewing physician licensing while enrolling and maintaining participation with payors this way is slow, inefficient, and not collaborative. As a result, licenses or payor enrollments are often put on hold or fall through the cracks. This delays patient care and can lead to lost revenue reaching hundreds of thousands of dollars for countless organizations.

Credentialing practices that rely on paper trails or a decentralized set of systems that are hard to track and reproduce, such as emails and Excel spreadsheets, create frustration for teams. Without a modernized, automated process in place, oftentimes errors are caught after they’ve become a potential revenue risk.

Our team has more than 30 years in the healthcare industry helping organizations to implement efficient day-to-day operating processes. We’ve seen firsthand the frustrations and chaos resulting from credentialing the old way and can say, with confidence, that implementing a simple, technology-driven credentialing process for your team can save time and money. It’s about having not only the right technology, but also the right team and process in place.

So how can teams be better positioned to avoid these credentialing pitfalls? Here are three key examples of why you need to modernize your team’s credentialing processes.

“Who’s on First?”

When it comes to credentialing, we see a lot of fragmentation within the same organization. Having different departments working with different processes means you’re probably duplicating credentialing work for some physicians and entirely missing others.

Getting consistent between multiple departments is key in order to avoid duplication and lengthy delays. A technology platform provides a bird’s-eye view within your own organization, helping your team figure out how to consolidate and standardize their process so everyone is working out of the same playbook. However, it’s not just about adding technology, it’s about adding the right technology — one that allows for workflow optimization and automated real-time updates and helps teams see where there may be problems within their organization and identify how they can close those gaps.

There is more efficiency in having one centralized credentialing record. Everyone has access to the same data and all in one place for different roles and responsibilities to utilize. Imagine having one centralized record for all credentialing data that can be accessed by both your team and multiple third parties. A truly centralized credentialing platform distributes information to all parties in a timely manner and removes the chance of error and delays that currently plague the system.

Additionally, a centralized record that belongs to the organization makes staff turnover a non-issue. The knowledge base and history stay in the platform, ready to be handed off. So there’s consistent coordination, stability, and efficiency across the board.

Creating a safety net

Credentialing processes, especially in smaller organizations, are often reactive. For example, your practice may receive a letter that a physician has to be re-credentialed or that Medicare enrollment has to be re-validated within 90 days. This, like many other credentialing processes, is dependent on a third party letting your organization know that something has to get done. Having your own structured system in place that’s proactive with timely alerts can save time and reduce reactive work that pulls resources from other projects.

Implementing a new technology to better track the credentialing process also creates a safety net ensuring any hiccups or challenges are identified early — in other words, making sure your internal team catches any issue before it gets to the physician or client. No one wants to do a fire drill every time a mistake happens. The reporting available when data is in a platform instead of on paper is crucial for helping identify problems and take action before anything falls through the cracks. Staff also feel more comfortable knowing their high-volume credentialing work is supported by reporting so anything they miss will be caught early. We’ve seen mistakes discovered months later that cost organizations hundreds of thousands of dollars.

The longer you wait, the harder it gets

Despite the benefits technology adds to the credentialing processes, your organization might balk at taking the leap because of the simple fact that you have done it on paper or in Excel spreadsheets for so long. Implementing a new credentialing process or upgrading the one you have can seem like a mighty task to take on initially, but getting on a centralized system more than pays off in the long run. The cost of not upgrading and the risk that presents to your organization are far greater than any challenges you may face implementing a new system.

Healthcare is changing, and to keep up, organizations need more sophisticated tools. Your teams need to be protected, and organizations need to be able to scale. With a growing number of payors, telemedicine, and organizational growth in general, the sheer volume of credentialing tasks at most organizations is making manual processes less and less manageable and increasingly risky.

Credentialing has become a key part of revenue cycle stability and preservation. In today’s healthcare system, the revenue cycle really begins with credentialing. Any organization that has experienced a pain point such as a claim being denied or not being reimbursed because of a credentialing issue can attest that the value add is pretty urgent. It’s time to take that leap; it’s worth the effort. In the end, it will benefit your team and your physicians and lead to better care for patients.

Marie Robertson is a Product Manager at Modio Health, and Sue Barton is Senior Manager, Engagement & Optimization for Modio Health.

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