As medical credentialing enables the patients to confidently trust their chosen healthcare providers, it has become very crucial. A medical practitioner cannot work at a hospital legally or partner with insurers, without proper medical credentialing. Only a new physician or practitioner who is credentialed is allowed to see patients, treat hospital inpatients, and receive insurance reimbursements. The new staff would fail to achieve the practice’s financial goals if they are unable to attain on-time credentialing.
What Does Medical Credentialing Mean in Healthcare?
Medical credentialing is, in short, an evaluation of a medical provider’s license, training, competence, experience, malpractice history, specialty certificates, and more. Medical credentialing refers to the process by which healthcare organizations, hospitals, and insurance networks confirm and assess the qualification of a healthcare professional. The process is important for both the doctor and the patient as it ensures that practitioners who are providing care are qualified to do so.
It’s essential for a provider’s credentials to always be accurate and current, and for them to follow the rules and standards implemented by the National Committee for Quality Assurance and The Joint Commission.
Medical practitioners have to go through the process of medical credentialing many times during their career, as the credentials have to be current. A credentialing specialist or biller usually starts the process either right before a medical practitioner is hired, or as soon as he starts working for a hospital, practice, clinic, or other healthcare facilities. This is because the whole process is quite lengthy taking anywhere from 3 to 5 months.
Medical Credentialing Prevents Healthcare Organizations from Revenue Loss
A primary reason to properly credential medical staff is to assure compliance to federal and state regulations. It is necessary for any medical office, that they partner with insurance companies. Physicians and other healthcare professionals are required to provide a list of verifications to insurance in order to be considered for reimbursement expenses.
If healthcare professionals fail to obtain credentialing, it can result in insurance carriers not reimbursing medical offices that bill for the professionals. The insurance carrier can backdate the reimbursement of the medical office to cover services offered, in the event that a medical office allows a professional to perform services prior to credentialing.
But, as the timeframe has a limit, there is always a risk that the medical office may end up losing thousands of dollars that might not be recovered from the insurance payer.
Protects Healthcare Organizations from Potential Lawsuits
Even the smallest medical mistake can cost hundreds of thousands in medical and legal costs, in today’s litigious society. Physician practices, hospitals, and other health organizations are increasingly being targeted for lawsuits, especially when the problems are the result of negligence to fully authenticate the professional credentials of the practitioners and others on their staffs.
In many states, there exist laws that require credentials on legal documents like medical records and prescriptions. Without proper credentialing, the hospital may miss on important things required by the law. Credentialing makes sure that a healthcare organization follows the letter of the law.
The process allows clinics to register to perform the National Practitioner Data Bank queries which enable them to have a look at the malpractice claims history of their providers. This allows them to practice legally and safely going forward.
Medical credentialing improves the patient trust
Trust between patients and medical professionals is a prerequisite in the health care system. Trust enables patients to open up and disclose information owing to their perception of better care and greater acceptance of recommended treatment.
Patients who don’t know much about their doctor’s qualifications are less likely to put their full trust in the doctor. Confirming and assessing the qualification of healthcare agencies and hospitals assures patients of healthcare professional’s experience and merit, thus allowing them to place their trust in their chosen providers.
Lowers the Risk of Medical Errors
According to an estimate, about 98,000 Americans die every year due to medical errors. This troublesome statistic forced industry leaders to campaign for improved standards of competency and introduce disciplinary actions against healthcare workers.
The risk of medical errors caused by incompetent providers can be reduced by credentialing healthcare providers. It’s even more relevant in the case of independent practitioners. Furthermore, since electronic credentialing uses automation tools, there is no room for human error or fatigue that is commonly associated with the manual evaluation process.
FAQs:
Q: Why is medical credentialing important for healthcare providers?
A: Medical credentialing ensures that healthcare providers meet the necessary qualifications and standards to practice safely and legally. It is crucial for obtaining insurance reimbursements, building patient trust, and avoiding revenue loss or legal issues.
Q: How long does the medical credentialing process take?
A: The medical credentialing process typically takes 3 to 5 months. It is essential to start the process promptly, either before a practitioner begins work or as soon as they join a healthcare organization, to avoid delays in patient care or insurance reimbursements.
Q: What happens if a healthcare provider is not properly credentialed?
A: Without proper credentialing, insurance companies may refuse to reimburse medical offices for services provided by the uncredentialed professional. This can result in significant revenue loss and may expose the organization to potential lawsuits or legal non-compliance.
Q: How does medical credentialing benefit patients?
A: Medical credentialing assures patients that their healthcare provider is qualified, experienced, and competent. This fosters trust, encourages open communication, and improves patient adherence to treatment plans.
Q: Can medical credentialing reduce the risk of medical errors?
A: Yes, credentialing helps ensure that only competent and qualified providers are allowed to practice, which reduces the risk of medical errors. Additionally, electronic credentialing tools minimize human error during the verification process.
