Healthcare credentialing is a time taking process. It involves many complex measures that billing specialists must follow to avoid suffering significant financial losses. Not only that but there might also be further legal issues that endanger the entire healthcare practice’s reputation.

A healthcare organization may be subject to malpractice claims and accreditation issues due to credentialing errors. Organizations run the risk of negligence claims that could lead to a lawsuit if they deviate from best practice credentialing procedures.

Credentialing Errors to Look Out For

The process of acquiring, evaluating, and thoroughly verifying a practitioner’s credentials is known as best practice physician credentialing. Although the proper credentialing procedures can be difficult and time-consuming, they are a hospital or healthcare facility’s fundamental duty.

Avoid these eight familiar physician credentialing errors made by practitioners and the facilities that certify them to reduce risk to your organization.

1. Practices Often Rely on Limited Staff

A healthcare facility must check all providers’ employment records and credentials, irrespective of their size. It includes educational background, training, residency, valid license, and all related documents. Each physician’s credentials must be done correctly – a massive task for a team to complete. Hospitals or healthcare facilities usually need more staff or resources to finish the medical credentialing procedure, leading to missed income and stressed-out employees making many mistakes.

2. Time Management and Planning Issues

A delay in credentialing means a longer wait before treating patients and providing services, wasting a physician’s valuable time. The facility needs to wait until a fresh, credentialed healthcare provider joins. If not, they won’t get paid what they should for their rendered care services, which will cost them a lot of money. Such situations result from inadequate resources and poor planning.

3. Data Entry Errors

To avoid any hassle during the credentialing process, data needs to be accurate unless it will further delay the whole process. It is one of the many areas where healthcare facilities make the most mistakes. Many errors come under this umbrella, such as typo errors and missing and incorrect information.

4. Issues Related to the Information

To continue providing quality care, healthcare providers must regularly renew their licenses and credentials. Providers need to be updated with their respective boards so there will be no reimbursement issue.

5. Failing to Report on Time

Practitioners need to report timely any adverse actions like revocation of license, clinical privileges, and all other related activities to report timely. Failing to do so will result in the physician’s omission, and the healthcare practices will be held responsible for this.

6. Know Your Deadlines and Make Appropriate Plans

Sadly, it has been said that waiting six months for credentials from insurers is common. As previously mentioned, some insurance companies demand credentialing before permitting payor contracts and payments. Planning future cashflows immensely benefits from having a thorough understanding of the specifics of the insurance companies’ issuance of effective dates.

Effectively Resolving These Credentialing Constraints

It may not be a good idea to handle the credentialing internally at your facility in light of all the potential credentialing errors listed above. Making the staff deal with time-consuming, massive amounts of paperwork robs them of the valuable time meant for patient care. They need to gain the skills and experience necessary to meet the process requirements, which could cost them a lot of money.

Healthcare practices can increase profitability with revenue cycle management (RCM) solutions as an effective RCM can also help to optimize the billing and revenue collection processes and eliminates the majority of billing and coding-related problems that a healthcare system faces. RCM solution paves the way for quick payments, prompt patient communication, and effective billing systems in medical practices. They can aid in accelerating the process in a variety of ways due to various features including:

1. Available on the Cloud

A cloud-based medical billing solution is one of the best features for any medical practice when implementing an RCM solution. Your IT department will be relieved because they won’t have to worry about finding enough server space to store and access the RCM data. Make sure, though, that the company you select for RCM installation provides 24/7 unlimited on-demand access to your data.

2. Verification of Eligibility

With RCM, managing data transactions online is simple, and routine eligibility checks are streamlined, saving your staff time and effort. Additionally, sophisticated software mechanisms aid in verifying prior authorization. To expedite the creation of co-payments and patient responsibility payment estimates, many practices regularly use RCM solutions as a practice management system.

3. Tracking and Fixing of Claims

Real-time tracking and status checking of submitted claims is another excellent RCM feature. Additionally, your staff can quickly edit and resubmit any of the denials in the software if a problem arises during claim submission.

4. Rejection Alerts

Setting up your RCM solution with proactive denial alerts is a smart way to lower or eliminate the claim denial rate. Each employee can respond to the alert by editing and resubmitting the claim using this feature.

5. Training Medical Professionals

Any RCM solution’s effectiveness depends on how well its user can exploit it. To decrease account receivable time, submit clean claims, and lower the denial rate for your practice, you should therefore inquire with the vendor about whether they provide thorough RCM training.

Therefore, before ordering the RCM and requesting training sessions, you should first request a demo to review the software’s features. Furthermore, a healthcare organization’s overall financial health is just one aspect of providing patients with top-notch care, and they can improve it by utilizing best practices for effective revenue cycle management. 

Change Platforms as per Requirement

Credentialing process expands with the expansion of business. Several healthcare practices collaborate with a wide range of providers, and everyone has unique credentialing requirements. The practices must integrate advanced revenue cycle management solutions to meet revenue goals.

The main issue here is that the medical facilities have a lot of data to take care of, which is daunting. It is one of the primary reasons why several healthcare practices are stuck with outdated platforms that affect their efficiency and productivity.

Increase Profitability with Revenue Cycle Management

The practice’s financial stability must maintain consistent cash flow. Many healthcare organizations have implemented a Revenue Cycle Management (RCM) solution to streamline and automate time-consuming financial and medical billing tasks to remain competitive. Therefore, before ordering the RCM and requesting training sessions, you should first request a demo to review the software’s features. Additionally, it will assist you in determining whether or not a particular solution can help your practice’s financial situation.