In the intricate web of healthcare delivery, one crucial yet often overlooked aspect is the physician credentialing process. Behind every trusted doctor-patient interaction lies a meticulous journey of verification, validation, and assessment, ensuring that healthcare providers meet stringent standards of competence and ethical conduct. This article delves into the complexities of physician credentialing, exploring its significance, challenges, and the vital role it plays in safeguarding the quality and integrity of healthcare services. From understanding the foundational principles to navigating the evolving landscape of credentialing in modern medicine, join us on a journey through the gates that safeguard the quality of healthcare delivery.
Medical Credentialing
Medical Credentialing is the process through which healthcare organizations and insurance companies evaluate and assess the professional documents of a healthcare provider-physician or doctor. The documentation includes the educational background of the physician, the work history, licensure, peer references, and misconduct history. Physician credentialing is an essential aspect of the healthcare industry, and without proper credentialing system, you cannot run a successful medical business in today’s world.
Here are some of the factors that determine the importance of medical credentialing system:
Increased patient trust
It is vital to have established a proper medical credentialing system to create an environment of trust between the healthcare provider and the patient. Your patient would not trust the physician unless you make the physician go through a rigorous credentialing process. On the other hand, if the physician is well-assessed before handling the patient, the patient will be happy and satisfied with the services.
Better patient experience
When you are confident about the eligibility of the physician, you create an opportunity for better patient experience as well. A well-educated and professional physician can provide the necessary healthcare to the patient. This can improve the overall patient experience, decreasing the risk of mishandling of patient.
Avoiding malpractices
A well-managed credentialing process can help your organization avoid having malpractices against patients. An unqualified individual is given no chance to play with people’s lives under such a system.
A better reputation
The medical industry today offers a lot of focus on medical credentialing services. To have a good standing in the industry, it is crucial to have error-free physician credentialing services.
Improved revenue cycle management
If the doctor or physician providing healthcare services to the patient is not thoroughly assessed, and the services are not evaluated, the insurance company might not agree on giving the reimbursements. To have a smoothly running revenue cycle and bring the provider on an agreement, it is essential to attain medical credentialing services.
The importance of a well-organized credentialing process cannot be denied. But here comes the real question: how to achieve all those benefits? It is hard to attain the smooth running of the medical credentialing process.
Let us discuss some of the tips that can help you accomplish the smooth running of credentialing process:
1. Check for the medical License
An active medical license is needed to practice in any state, be it solo-practice or practice in an affiliated hospital. The medical license is provided by State Medical Health. Majority of the medical licenses need to be renewed after every two years. Check for the past medical license of the physician as well.
2. Eligibility status and Board Certification
The individuals who have completed their medical education and residency training are provided with an eligibility status by a certified board, i.e., American Board of Medical Specialties. Without this certification, the physician should not be considered eligible to interact directly with patients.
3. Peer evaluation
It is vital to have information about the peer references of the physician. It also includes the assessment of the individual done by co-workers, training program directors, and other professional people who have interacted with the individual.
4. Medical School Degree
It is the first and foremost duty of the medical credentialing services providing a team to look for and assess the medical school degree supplied by the physician. Only universally-affiliated medical colleges should be considered, and the physicians who do not have a certified degree should not be allowed to practice.
5. Investigate any malpractice claims
Malpractice claims against a physician can imply that the physician has not exhibited the desired workplace behavior. It might tell you many other facts about the physician as well, such as the inability of the physician to treat with patients, which can result in bad patient experience.
6. Ensure the accuracy of the credentialing process
To have a smooth running of the physician credentialing process, it is always advisable to ensure the accuracy and efficiency of the system. Make sure that your system does not contain human errors, and the whole process is unbiased.
7. Focus towards the creation of a sustainable credentialing process
The credentialing process can take months and cost you large sums of money, but you should still focus on a sustainable credentialing system. Systems that can help you acquire long-term satisfaction and can provide you with long-term physician credentialing services.
8. Consider Outsourcing physician credentialing services
Outsourcing physician credentialing servicescan save your organization a lot of time and money. The outsourcing companies can carry out the whole task at a much higher pace and with a lot of accuracy than an in-house credentialing team. Credentialing companies have an already established network in the industry and hence can save you from the hassle of dealing with denials and delays. Outsourcing companies mostly demand a share in the revenues, which is a much lesser cost compared to the cost of holding and managing an in-house credentialing team. Despite being tedious and time-consuming, credentialing is a complicated process that not everyone can understand. It is always a good idea to outsource the physician credentialing services.
These were some of the factors affecting the credentialing system and tips on how to manage the system aptly. There are many consultant companies providing credentialing services, but only a few truly understand the actual market need. We have shortlisted one of the very few companies that has been offering medical billing and coding, and physician credentialing services. It has earned a reputable standing in the pharmaceutical industry through the hiring of top-notch employees. It has been serving in 22 states and has provided its services to more than 100 practices. You can consult SybridMD for physician credentialing services.
The company provides its customers with a cost-efficient system that helps the organizations deal with the costliness of the credentialing procedure. It offers its services to both group and solo-practices as well as to big hospitals. The services provided are unique, customized, and with accordance to the demand of the customer. It has specialized staff that has years of experience in the medical billing industry.
