Elevating Medical Standards: The Critical Importance Of Thorough Credentialing

Credentialing is a process whose importance can’t be understated. Medical organizations use this procedure during employee onboarding, helping them analyze practitioner’s backgrounds.

Credentialing is vital for everyone involved as it ensures the highest quality standards and full patient protection.

In this article, we’ll explain what credentialing is and how a medical business can benefit from it. We’ll also briefly talk about the benefits of hiring a credentialing verification organization to expedite the process.

What is Medical Credentialing?

What is healthcare credentialing?

What is healthcare credentialing

Credentialing is a process during which a medical institution verifies a practitioner’s medical degree, experience, and malpractice claims.

The main purpose of credentialing is to ensure that a person is well-equipped for a role and that they want to cause harm to patients. As most medical professionals work without supervision, you need to be certain they can deliver quality service.

How do you verify a practitioner’s credentials?

Given that we’re talking about health, credentialing is designed as a very meticulous process meant to cover all the angles.

A medical provider is responsible for analyzing all relevant documents and corroborating their validity. In theory, you should consider all available information, even if they’re based on word-of-mouth.

Besides the obvious ones, which are work experience, education, and training, here are a few other things you need to go through:

  • Basic practitioner’s details such as name, email address, phone number, and ID info
  • Demographic data
  • Social security information
  • Passed drug test and immunization
  • Info regarding lawsuits, malpractice claims, and any other relevant sanction
  • Peer references
  • Liability insurance plan

Back in the day, credentialing was mostly done over the phone or email. Luckily, nowadays, companies can track relevant data by utilizing advanced software and checking relevant databases.

This method can significantly reduce time spent on practitioner onboarding, thus boosting user satisfaction.

How long does credentialing last?

Besides having to tackle so many documents, credentialing is notorious for being slow.

It takes anywhere from three to six months to verify a practitioner, which can pose an enormous financial burden on a clinic, given that the medical organization has to cover the salaries during this time. Don’t be surprised if you don’t manage to do anything on some weeks.

What’s worse, you need to renew these credentials every two years. All of this can be a major issue for smaller clinics and medical institutions that don’t have specialized credentialing staff (which is most of them).

Employees are often forced to take time off just to take care of the process, distracting them from their usual activities.

Outsourcing credentialing as a potential solution

Truth be told, credentialing can be so annoying that most employees don’t even want to tackle this task. Yet again, it’s something you need to take seriously, as it can affect your profitability and user satisfaction.

As a way to circumvent the issue, hospitals and clinics often hire external credentialing providers.

These specialized agencies are well-connected with the boards and other regulatory bodies and are always on top of the latest laws. They understand how to execute the process in minimal time, thus saving you money during employee onboarding.

Credentialing organizations utilize advanced software that connects them to large medical databases. They can quickly extrapolate insights about different practitioners, thus saving a lot of time.

Besides that, relying on digital solutions and external providers can also prevent common errors that occur when inexperienced employees tackle this task.

5 Main Credentialing Benefits

5 Main Credentialing Benefits

Regardless of your business’s size and specialization, credentialing is something you can’t live without. These are the 5 main things you need to consider when introducing the procedure:

Improves reputation

Trust is the basis of every healthcare service. In the end, if you don’t trust the person who’s giving you medical treatment, you probably won’t allow them to tinker with your body.

When in the hands of a fully licensed and qualified professional, patients are more likely to visit your clinic over and over again.

As such, this not only improves lead generation but also client retention. Reputation is also critical for scaling the business, especially if you’re located in a highly competitive market.

Increases revenues

Single practitioners, clinics, and hospitals make the most of their money by partnering with insurance companies. They sign a specialized document with these institutions referred to as a payor contract.

After signing a contract, medical providers can treat patients with healthcare plans and, in return, receive reimbursement for their services.

One of the basic rules of a payor contract is that a healthcare provider needs to be credentialed. Otherwise, they’re not even eligible to sign the document.

In other words, if you don’t have a valid contract, you’re missing out on all the potential clients covered by a healthcare plan.

Reduces medical errors

Medical errors are one of the biggest reasons behind unnatural deaths, leading to a number between 44,000 and 98,000 casualties each year.

Among others, patients might suffer due to miscommunication, drug side effects, slow service, lack of medical data, malfunctioning equipment, and so on.

While you can’t fully eliminate errors and subsequent deaths, credentialing can partially alleviate the issue. By hiring highly specialized experts, you can rest assured that the right people are on the job.

Insulates from lawsuits

Proper credentialing also plays a role during lawsuits. If one of your employees is sued for malpractice, you can protect the clinic from liability. As a result, you can avoid hefty fees that can be a result of an indictment.

Higher user satisfaction

Credentialed medical practices usually have higher user satisfaction. If patients are certain that your team consists only of verified experts, they’ll feel at ease when visiting your clinic.

Based on everything we know, even the fact you have credentialing will result in more positive reviews and higher retention.

Hiring external CVOs is especially beneficial during this step. These companies are faster at executing credentialing verification, ensuring that practitioners start working much quicker.

As a result, patients will gain access to more specialists, which will result in faster service and higher satisfaction.