medical credentialing

Most Effective Ways To Overcome Medical Credentialing Services Problem

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Medical credentialing is a key factor for hospitals and healthcare providers, as it aims to validate the qualifications, certifications, work experience, and references of the medical provider, physician, or doctor.

Most of the patients are not aware of the qualifications, background, certifications, and credentials of their medical service provider. This has increased the importance of medical credentialing because it is a process that allows the patient to place greater confidence and trust in the chosen healthcare provider.

The medical credentialing process poses a critical challenge to hospitals, medical clinics, physician offices, and ambulatory surgery centers. The process is capable of causing significant delays in recruiting and hiring new clinical staff and getting reimbursed for the medical services rendered.

A study in the healthcare industry has revealed that two out of three credentialing processes took 5-6 weeks longer than the usual schedule. There have been suggestions like the insurer, healthcare provider, and hospital should act as a single unified platform. They should have access to a standard data set to speed up the medical credentialing process. 

Through a simplified and standardized process consisting of primary source verification, data collection, and committee reviews by hospitals, healthcare agencies, and health plans, patients get assured of the merit, performance, and experience of their healthcare provider. With the arrival and advancement of various web services and technological innovations, medical credentialing has become a major area for enhanced efficiency, as well as, increased improvement process. 

Automated solutions: The importance of electronic medical credentialing

Generally, a healthcare provider needs to do a tedious, cumbersome, paper-based medical credentialing. This burden can be reduced to a great extent. The electronic medical credentialing process offers greater organizational efficiency, thereby positively impacting the quality of the healthcare organization. 

Despite a tremendous revolution in technology, healthcare organizations are still relying on the manual outdated paper-based medical credentialing process, which is evidently slower and does not guarantee any transparency.

With a single human error, while handling paper documentation necessary for medical credentialing, a doctor might be allowed to offer his services even after the expiry of his medical license or a nurse could be permitted to offer her services beyond her relevant experience. This can have an extremely serious negative impact on the safety of the patient, professional survival of a physician, and the reputation of an affiliated institution.

Most of the healthcare professionals have overlooked the advantages of a streamlined medical credentialing process. Regular monitoring is generally ignored due to time constraints and cost factors. In most cases, obtaining the data manually and verifying each physician can take up to several days or even months for the processing to get complete.

The good news is that the most effective way for healthcare organizations to overcome the problem of manual credentialing process is to invest in automated credentialing solutions, which will expand their access and meet the benchmark for improvement in the quality of care while cutting down the overall cost.

In response to the hurdles posed by manual processes, electronic medical credentialing service eliminates major errors and reduces the cost by allowing real-time screening in the organization.

Outsourcing emerges to be a lucrative alternative option for overcoming medical credentialing service problems

Third-party solutions use robust web-based software platforms that effectively integrate data collection, provider verification, and reporting to achieve the most out of the electronic credentialing.

This process allows healthcare providers to reduce the chances of fraud and eliminate wasteful data immediately by centralizing the data of the provider. Also, they are adequately able to meet the continuous compliance requirements for verification of the qualifications of the staff.

Ensure provider data is current and accurate

It should be ensured that the provider data being entered into the credentialing system should be accurate, complete, and correct. 

More than ever, healthcare providers are expected to ensure greater safety for their patients. Real-time accurate credentialing can be an extremely significant factor in achieving the goals of an organization.

Streamline the operations and communication is the key

Overcoming medical credentialing service problems is a rigorous team effort. Resources from finance, human resources, risk management, and IT all need to work together with the provider enrollment and medical staff in order to coordinate well and report the minimal loss.