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3 Factors for Improving Your Provider Credentialing Services Program

Posted by Matthew Smith on Jun 6, 2012 5:00:00 PM

 

provider credentialing servicesWhile your provider credentialing services program might be a low-profile function within the overall healthcare management landscape, lapses in credentialing can open an organization up to malpractice suits or accreditation troubles. The solution is a centralized credentialing function resulting in reduced costs and improved outcomes via a consolidated team across the entire enterprise.

Recent developments in health care continue to expose the weaknesses in the traditional credentialing approach. Larger medical groups are built as the result of consolidation, and administrative staff struggle to keep up with the demands of physician onboarding. On top of that, growth in physician employment by hospitals is rapidly expanding the volume of credentialing work by staffers already stretched thin.

The solution lies in provider credentialing consolidation: a professional, centralized unit that handles all credentialing, privileging, and related tasks. The results are clear from succesful organizations who have installed a centralized approach: Measurable staffing cost reduction, service improvement, and revenue cycle optimization.

To achieve the right mix of organization, staff skills, processes, and tools, Health Directions has identified 3 factors necessary to improve provider credentialing services:

1. Create a Specialized Team

Specialization is the foundation for effective provider credentialing. This team should focus entirely on the the provider credentialing, privileging, and related functions and should not have side responsibilities (i.e. billing, administration, or recruiting).

2. Use Dedicated Credentialing Software

Effective credentialing teams use specialized software to coordinate credentialing information, automate functional expertise, manage workflows, and ensure continuity. Several vendor packages are available and have varying strengths and weaknesses but all offer benefits that homegrown systems cannot.

3. Take a Flexible Approach to Outside Resources

Many external credentialing services are available and can be integrated with in-house efforts for greater efficiency and cost-effectiveness. Outsourcing certain portions of credentialing also make sense. Some organizations may want to handle hospital privileging and government credentialing and would outsource commercial payer credentialing.

As the provider consolidation trend continues, a centralized--and sometimes outsourced--credentialing team will help avoid pitfalls and support positive working relations with all parties involved.

Topics: Provider credentialing services, outsourced managed care services, credentialing

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