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Medical Credentialing Process for Physicians- Top 5 Mistakes to Avoid

What is Physician Credentialing In Medical Billing?

Physician Credentialing is a formal process that uses a consistent set of guidelines to ensure patients receive the highest standard of care. From carefully vetted healthcare professionals and their medical abilities. The credentialing also assures patients that they are being treated by a provider whose qualifications, training, licensure, and ability to practice medicine are acceptable. Moreover, Physician Credentialing also ensures that all healthcare workers meet the same standards.

Importance Of Physician Credentialing

Physician Credentialing is very important for clinics and hospitals. Not only does it improve the credibility of medical institutions. But it also protects patients from medical errors caused by unqualified medical professionals. Physician Credentialing ensures that clinical practitioners are appropriately qualified, licensed, and accredited. It allows patients to trust the provider of their choice.

Many medical practices are considering getting physician credentialing to respond to emergencies. Payments for medical services may also be denied or delayed without proper credentialing. Credentialing, once seen as a regulatory burden, is now critical to a healthcare organization’s business.

Difficulties in the Physician Credentialing Process

Ensuring a hassle-free credentialing process can be difficult because it takes months of planning, especially when new doctors join a clinic or hospital. Physician Credentialing is also a cumbersome process as it includes more supporting documentation and regulatory linkages. The time and money required to find each medical provider can drain a hospital’s resources, shifting the focus away from administrative tasks.

Physician Credentialing is difficult for many healthcare organizations. Due to a lack of dedicated staff, financial constraints, or a lack of required information resources. This is why outsourcing is preferred. In the case of outsourcing, the hospital does not have to take responsibility for possible oversight or errors in the credentialing process. In the process, even one mistake could affect the outcome of future audits, leading to penalties.

Avoid Common Credentialing Mistake 

Avoiding common credentialing mistakes is not as difficult as you might think. Physician Credentialing is an easy process, at least on paper. Information about provider qualifications employment history, education, credentialing, licensing, etc. will be sent to payers for review and verification. After they go through a thorough inspection process, the payer confirms the service provider and starts compensating him for the services he provides.

Physician Credentialing is the process of a thorough review of a physician’s professional record. This typically includes examining the doctor’s education, licenses, credentialing, and practice history. This is a prerequisite for hiring a doctor for a new clinic or hospital. Physician Credentialing is a time-consuming and labor-intensive process that typically takes an average of ninety days to complete if there are no obstacles.

Successful medical credentialing requires careful planning by physicians to avoid issues that could hinder the review process or lead to outright denials. Hiring the services of a professional is recommended to facilitate the process and avoid pitfalls. 

Below we discuss the top 5 mistakes made during the credentialing process due to a lack of knowledge or insight.

Preparations start late

As mentioned above, the authentication process is time-consuming. Therefore, it is very important to start the process as soon as possible. A lot of time should be spent filling out the application form, compiling the necessary documents, and making sure the licenses and certificates are up to date. Not allocating enough time to these tasks can lead to huge mistakes when trying to rush everything.

Incomplete/missing information

When completing credentials, attention to detail is critical. It is necessary to provide all required information as accurately as possible. Failure to do so can greatly hinder the application process. It’s a good idea to review the full application documentation several times to find bugs. In addition, it may also be beneficial for a third party to conduct a thorough review of the document before submitting it to the credentialing board.

Do not monitor NPDB

The National Practitioner Data Bank (NPDB) is a national database used to collect information on physician malpractice resolutions, convictions, or other adverse information. This information is usually provided to the credentialing board upon request and is an important determinant of whether a physician passes the credentialing process. Therefore, close monitoring of NPDB by a physician is important; any additional information requested must be provided promptly. False reports must be challenged and corrected as soon as possible.

Expiring CAQH

The Council for Affordable Quality Healthcare (CAQH) is an online database that stores all the information needed for physician credentialing. CAQH is designed to simplify the approval process by easily providing the required information to interested parties, thereby reducing approval time. Some organizations use this medium in their physician credentialing process; therefore, it is important to update the information in the CAQH frequently and regularly. Neglecting to maintain the CAQH may hinder the credentialing process of boards that obtain medical information through these means.

Failure to meet government health plan standards.

Most credentialing processes require doctors to enroll in several government-backed health plans, such as Medicare and Medicaid. The enrolment process in these programs varies, and unknown errors may occur when attempting to enroll in these programs; these errors may delay physician approval. To reduce the chance of error, it is advisable to use the services of experts familiar with the nuances of government health plans.

Ultimately, the best way to avoid mistakes that can hinder or even hinder the Credentialing process is to use professionals who are familiar with the entire process. At I-Med Claims, we have qualified teams always ready to work with you to simplify and expedite your claims process. 

Hire I-Med Claims For Credentialing Process Now 

Documenting and successfully managing a Physician Credentialing Process is an important task. This expensive and time-consuming process needs to be handled in the right way. Physicians will not be paid to provide medical services if they are not fully enrolled or certified with the health plan in which they participate. Hiring I-Med Claims with expertise to help develop a complete strategy and provide complete credentialing services is an option that benefits growing practice revenue dramatically. However, the lack of information will also affect their chances of attracting more patients.

Be sure to provide the required information and attach all documents to avoid rejection of your certification form. Contact us today for more information.


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