This is the life of a typical healthcare practice manager:

It’s 9 PM on a Friday. You’re still at the office, scrambling to finish the initial credentialing applications for the new providers joining your practice. Your desk is covered with 2-inch-thick personnel files, but you’re still missing documentation for all three of the providers. The last time you spoke to Dr Smith, he was rifling through his attic for his MD diploma. Dr Miller can’t remember which CME course she took six months ago. And Dr White, who isn’t responding to your texts, calls, or emails, hasn’t finished his Delineation of Privileges form. Time’s running out, you’re exhausted, and in the back of your head, you’re wondering why your practice has to do all of this on paper. You’ve heard about credentialing software before, but it must be pretty expensive. Besides, there’s no way it could do everything you need – or else, why would you still be at the office?

Sound like a nightmare? For many practice managers, this is real.

Here’s the problem: American healthcare is in crisis. The recent Obamacare health insurance law reform has brought in 32 million new patients (with an estimated 36 million more joining Medicare in the next 20 years), but barely 100,000 physicians currently practice in the U.S. We desperately need more doctors, and yet physician credentialing – the very process that vets a doctor for practice – remains the most broken, outdated system in the business.

Cost is the first (and the worst) issue. Every year, your medical practice could spend over $7,000 on each provider’s credentialing application. The average physician spends 43 minutes a day interacting with health plans instead of their patients while administrators spend 20 hours to credential every provider. Administrative tasks are so demanding that practices lose nearly $100,000 in staff wages every year. (If you belong to a specialty group, that number goes up.) Still, it’ll take 2-3 months before that new doctor can even start working… if everything goes smoothly. MCOs have strict application guidelines, and it’s tough to jump through all the hoops. One requirement is proof of malpractice insurance, which can range from $10,000-$100,000 or more a year per provider. You might get sticker shock, but insurance isn’t optional – not when medical errors are the 3rd leading cause of death in the US.

Clerical medical errors can also cause giant problems. Up to 85% of credentialing applications are incomplete. Leaving dates blank or writing a “See CV” note saves time, but the application will still get rejected. Is the provider’s state license still pending? Good luck. The average 60-90 day wait for credentialing can quickly become twice that, especially since health plans won’t process an incomplete application. Can your practice wait that long?

If your physicians aren’t credentialed in time, it’ll put the brakes on patient scheduling, delay billing and coding, and expose patients to a doctor who hasn’t been fully vetted. Medicare and Medicaid both block un-credentialed providers from billing for their services. Skirt this rule by billing under another credentialed doctor’s name, and you’re looking at an audit. Plus, a provider without credentials hasn’t yet cleared the background checks, affiliation requests, and other security measures required for patient safety.

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What can you do, then? Here’s some quick tips to ensure that your team of physicians is fully credentialed (and getting paid on time):

  • Hire credentialing coordinators (or train your management staff). Spare your medical staff the administrative burden. Can’t afford another worker? Hold a training session for your staff, and join the NAMSS or MGMA network so you’re equipped with the right resources.  
  • Move your records to the cloud (or at least to your computer). What happens when a new practice asks you for your previous doctor’s work history? You don’t want to ignore that request (it’s not worth the liability risk), but you don’t want to dig through those 15-year-old file cabinets, either. If you still need a good horror story to convince you, check out the Kadlec case. Keeping records in the cloud could spare you a lawsuit.
  • Use physician management software. There are plenty of software packages available for physician management, but they’re not all equal. A good system should be web based, ensuring easy access to the software for all staff. Expect your software to keep track of licenses, have unlimited documented uploads, electronic signatures, CAQH integration and include primary source verification for your providers’ data. Run a cost-benefit analysis, too: often the biggest, flashiest names in the market aren’t offering the best deal.   

In the end, while you can’t dodge credentialing fees, you can avoid expensive mistakes. Update your systems. Keep your staff happy. Efficient credentialing can’t happen overnight, but it can always get better.

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