Smart Credentialing Practices
Healthcare consultant Larry Kemp, managing partner of PRS Consulting, said effective credentialing of physicians is critical for a practice’s revenue stream. Without an accurate and well-documented credentialing process, payment delays and denials will follow, he said.
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Explore This IssueApril 2019
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“Ignoring provider credentialing problems will result in lost income,” he said. “And the practice with effective processes can control many actions.”
It’s a time-consuming and labor-intensive process, he said, but unavoidable.
Applications for credentialing should be accurate and they need to be monitored until they’re approved. Also, he said, a practice should keep an electronic database of its providers. Re-credentialing also needs monitoring. Understanding the process will help a practice stay ahead of the game.
To oversee credentialing the right way, he said, all contracts and service providers have to be inventoried, including all payers, networks, products and locations. Provider names, dates of birth and National Provider Identifier (NPI) and Social Security numbers must be confirmed. The Center for Affordable Quality Healthcare database info must be up to date. Accurate supporting documents must be retained. Medicare revalidation issues must be handled while staying ahead of due dates. Know when credentials expire.
For new providers, credentialing should begin three months before their start
date, he said, with obtaining their NPI, controlled substance registrations, Medicare enrollment, malpractice insurance and
hospital privileges all on the to-do list.
For current providers, the front office of a practice is key to keeping information accurate and preventing payment delays.
Thomas R. Collins is a freelance writer living in South Florida.