5 Ways to Improve the Credentialing Process

5 Ways to Improve the Credentialing Process
Senior Director of Marketing

Medical staff services professionals are on the front line of patient safety, but their work often requires maneuvering a path full of inefficiencies and roadblocks.

“Credentialing can easily take three to four months, and sometimes even longer,” says Jill Schwieters, President of Cielo Healthcare, which provides recruitment outsourcing services. “Many times the providers need reminders to provide all of the necessary documentation required for the credentialing process, as it can be rather overwhelming for the provider, who is often working in a busy practice or completing residency or fellowship training.”

Here are five steps you can take to improve the credentialing process.

Adopt a Strategy of Standardization

Credentialing can feel like a haphazard, just-in-time process. Healthcare organizations need credentials as soon as possible, and credentialing departments may postpone some tasks to put out fire elsewhere, then fall behind on what they were working on.

Standardization is the key, says Marshall Baker, who works as a Business Consultant for physicians and is an Educator with the Accreditation Association for Ambulatory Health Care. Standardizing the credentialing process for the professional staff and other providers can get everyone on the same page and reduce the chance for error.

One way to do this is to start with standardized “core privileges” for each specialty’s scope of practice to simplify the process of establishing what each provider can perform.

Embrace Technology

Some medical staff services departments still rely on paper files to keep track of licenses and certifications. But those paper systems are outdated and can introduce risk into the system, Baker says. Advances in technology have made it possible to easily capture and store the information needed for credentialing, he says.

Baker recommends automating processes and record keeping, and setting up notifications when licenses and certifications are near expiration. In addition, he recommends assembling easy-to-follow checklists for different positions or departments.

Centralize Your Approach

Systems with multiple locations often make things hard on themselves by requiring a different medical staff application for each facility the provider will be working at, Schwieters says. Credentialing processes can cover the same ground several times by asking for the same information or checking with the same sources.

Tech tools can reduce some of these issues, but internal changes may take more effort, Schwieters says. While some privileges will still require board or CMO approval, a centralized approach that requires just one application can save time and effort.

“Although this will take significant time in adjusting governance, negotiating with physician leadership, changing bylaws and decades of practice, in the long run [it] will be more time efficient,” she says.

Collaborate with Other Teams

Healthcare organizations are often divided into silos, making it difficult for different departments to work together. IT is a good example; every department uses IT services, but departments tend to not interact with IT unless there’s a problem or an update. Improving the credentialing process will mean departments that don’t often interact — such as IT and operations — will need to gain consensus on different processes, Baker says.

Schwieters adds that those who don’t understand the process may try to make changes that aren’t helpful, so communication is vital. “Those who are not directly managing the process may be uninformed and begin to distrust their credentialing colleagues,” Schwieters says. Department leaders will need to commit to transparency and to working toward common goals.

Stay Current

Members of credentialing and medical staff services departments should look for ways to keep their knowledge up-to-date, experts say. Getting involved in professional associations such as the National Association Medical Staff Services (NAMSS), networking with peers and reading updates from organizations such as the Center for Affordable Quality Healthcare (CAQH) will help them stay current on best practices in the industry.

“Providers who stay current with CAQH don't have as much difficulty with the credentialing process anymore,” says Stan Loskutov, CIO of Medical Billing Group. “The only challenge that remains is to keep all the documents up-to-date and to renew them in a timely manner.” Use your technology to set reminders and prompts to ensure compliance.

Credentialing can be a headache for health systems and clinics of any size. But by standardizing it through the use of technology and staying up-to-date on best practices, credentialing departments will reduce inefficiencies and improve the process across the board.

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