Why Delegated Credentialing Matters in Modern Healthcare?

After patient treatment, credentialing is often categorized as the most important procedure for a healthcare provider. The process is vital for onboarding new practitioners and ensuring faster payer reimbursement. Unfortunately, despite its importance, this process usually comes with its fair share of obstacles.

So, to simplify the procedure, providers rely on modern credentialing software and external providers. These platforms help medical professionals keep track of various documents, such as professional certifications and licenses.

Having the right credentials is especially important for governmental agencies as it shows them that your clinic has the necessary paperwork for treating patients. However, credentials are also crucial for clients as these documents allow patients to gain better insights about a particular healthcare provider.

What are the common credentialing issues?

Today, it’s common for physicians and other medical entities to have credentialing policies. Unfortunately, there are always issues when there’s a new policy in place, and the insurer has to adjust to it. In most cases, insurers are looking for modifications so that this new policy is more suitable for their businesses.

Not having proper credentialing can single-handedly destroy smaller providers. The process of credentialing sometimes takes up to 90 days, during which time a company can lose hundreds of thousands of dollars in revenues. As a result, healthcare entities often avoid onboarding new professionals to avoid these massive costs.

How often do healthcare providers perform credentialing?

So, what is delegated credentialing?

Credentialing is a periodic process that helps ascertain the current status of physicians and healthcare organizations. According to the current US laws, professionals have to perform credentialing once in two/three years.

Keep in mind that credentialing is done separately for each office. For example, if a healthcare provider has several clinics across the city, it’s necessary to provide credentials for each location and all medical experts.

How to start with delegated credentialing?

The idea of delegated credentialing sounds incredible to healthcare providers. In the end, who doesn’t want to eliminate a tedious administration task from their daily operations?

Unfortunately, despite both sides’ best efforts and using advanced software, the process can still be tricky. For the most part, the success of the entire procedure hinges on two things:

·       In-house implementation

Before signing any contracts and starting a relationship, the service provider must ensure that the client has covered all bases for successful credentialing. In other words, a provider will review the healthcare provider’s internal policies and procedures, as well as all pertaining documents.

To stay on the safe side, the service provider will also go through historical data. They will take into account the healthcare company’s staffing and performance and previous credentials. The most important thing is for the client’s procedures to comply with the current NCQA guidelines. Otherwise, insurers won’t be willing to do business with them.

NCQA Credentialing Accreditation ensures that a practitioner has undergone a meticulous credentialing process that verifies practitioners. Besides adhering to NCQA policies, the healthcare organization must also work in accordance with any relevant local and state laws.

·       Delegation agreement

Once everything’s covered, it’s time for parties to sign a delegation agreement. Like many other contracts, the document outlines both partners’ obligations. This includes performance evaluation, reporting frequency, and other relevant procedures. Among others, the contract explains what happens if one of the sides is in breach of the agreement.

When the provider and client sign the agreement, the delegated credentialing provider will regularly send an updated roster to ensure that all data is valid. That way, your health organization can also collect reimbursement in case of major changes.

What are the biggest benefits of delegated credentialing?

Delegating credentialing is a sophisticated process that can provide numerous advantages to the client. The most notable one is reducing the time required for enrolment. The process is extremely arduous and expensive, so the company’s main priority should be to hasten the procedure as much as possible. In the end, faster turnaround results in much faster payer reimbursement.

Keep in mind that fast external credentialing also provides benefits to patients. Through faster onboarding, physicians can start treating their patients as soon as possible. This is vital for understaffed clinics and sought-after experts.

Lastly, it’s worth mentioning that delegated credentialing also helps healthcare organizations with control. In other words, the client hospital or clinic can better manage how the network is presented in directories. Through enhanced data accuracy and full compliance, business entities don’t have to worry about otherwise stressful processes.






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Medical Device News Magazine provides our readership with breaking medical device / biotechnology news. Our subscribers include medical specialists, device industry executives, investors, and other allied health professionals, as well as patients who are interested in researching various medical devices. We hope you find value in our easy-to-read publication and its overall objectives! Medical Device News Magazine is a division of PTM Healthcare Marketing, Inc. Pauline T. Mayer is the managing editor.

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