Medical credentialing is critically important to providers, healthcare organizations, and patients. The credentialing process allows patients to trust that the hospital or medical practice clinician is up-to-date in their field. But far too often, this process is a tedious, paper-based process whose requirements are as varied as individual health plans. Here’s why credentialing is so important to your facility and the providers that serve in it.
Why Credentialing Matters
Credentialing is a process of gathering, assessing, and verifying the background, qualifications, and legitimacy of a physician’s education, training, and licensure. It’s a standard that validates the doctor is competent and qualified to provide high-quality care to patients.
Far from being just paperwork, medical credentialing adds an element of validation to the doctor’s practice that matters to patients and your reputation. This process is usually conducted just before a doctor is hired. Insurance payers also may have a process before the provider is added to a list of approved in-network doctors. But there are also other benefits that make credentialing important for your hospital.
There is an element of trust that happens between the provider and patient. Break that trust, and you’ve lost a customer. Credentialing is a way to assure patients that the physician is working to the top of their license and has received the most up-to-date information on the care they provide.
But credentialing also ensures the provider has a strong relationship with the insurance payer. This translates directly to your bottom line. Insurance carriers require regular confirmation of a list of credentials from your clinical teams. If the carrier doesn’t have these details, you don’t get paid. Medical credentialing allows your on-staff doctors to bill the insurance companies of your patients. Insurance reimbursement for rendered services is what keeps the lights on in your hospital.
Credentialing also may lower the risk of medical errors, which is a huge problem in the healthcare field. Credentialing a provider means they have received the training they need to be efficient and effective at the practice of medicine. A key part of the credentialing process involves the evaluation of the doctor’s health practice history. In this way, credentialing can work in the hospital’s favor by weeding out any doctors who lack the fitness to remain a preferred provider.
Medical credentialing also improves the reputation of your employed physicians. More and more of your patients are doing online research into providers before receiving care. It’s critical for hospitals and doctors to manage their online reputations. Credentialing validates the skills of the doctor and, in turn, reflects well on the hospital itself.
Many states also require credentials for legal documents such as medical records and patient prescriptions. Without credentialed doctors on staff, you decrease your hospital’s risk of non-compliance. There are also rules around speaking engagements, research publications, and legal testimony. Credentialing allows healthcare facilities to query the National Practitioner Data Bank to look at the malpractice claims history of doctors.
FoxHire can help your organization hire physicians and take on the credentialing challenge. If your healthcare facility is struggling to keep up in these areas, we can help.