Mastering the Credentialing Process: Top Mistakes to Avoid for a Seamless Journey

Michelle Ofiwe
04 Apr, 2023 updated

The credentialing process isn't quick—it can stretch from 90 to 120 days, demanding both money and manpower. Rural health organizations often struggle with the resources needed for such a detailed task.

Many rural healthcare providers find themselves in a tight spot due to the way they're paid and the slim resources at their disposal. This crunch makes it tough for folks living in the countryside to get the healthcare they need. But there's hope. By getting smarter with data and joining forces with others, rural healthcare can find its footing even when the financial odds are against them.

To turn rural healthcare around, we need to simplify three key processes: finding a doctor, being a doctor, and compensating a doctor. Each step faces hurdles, all of which boil down to issues with data management.

Data's Role in Rural Healthcare Revolution

Take, for instance, a healthcare provider puzzled over why snagging an appointment for addiction treatment felt like a wild goose chase for patients. Digging into the data was crucial. It could reveal several things: maybe there were plenty of doctors, but they were like needles in a haystack on the provider's website; perhaps there was a dire shortage of professionals, signaling a need to attract more talent; or it could turn out there were enough doctors taking new patients, but they were booking appointments so far out, it was as if they were unavailable.

A significant roadblock for many rural healthcare entities is their reliance on outdated electronic health record (EHR) systems, with some still stuck in the paper age.

Not having a state-of-the-art EHR system makes it a headache for these health institutions or clinics to track missed health screenings or spot patterns in patient care. And while health plans do their best to share data with rural providers, the approach is anything but uniform, each offering a different portal. Healthcare workers simply don't have the bandwidth to juggle multiple portals or wrestle data into a spreadsheet — especially when their EHR system can barely keep up with the influx.

Data management is a colossal challenge in rural healthcare, with staffing issues at the heart of the problem. Many rural healthcare providers lack a dedicated team to build and maintain a data infrastructure, leaving them unable to fully leverage the data they collect. They're also missing out on the benefits of EHR integrations, which would make data more accessible to healthcare professionals.

Bridging the Gap in Rural Healthcare Through Creative Alliances

A big hurdle facing rural healthcare providers is the changing tide of how they get paid. The good old days of cost-based reimbursements, which once allowed rural health systems to flourish, are giving way to models like Medicare Advantage, which often fall short in covering costs. This has left many rural healthcare providers grappling with financial losses.

Reyann Davis, who leads value-based care initiatives at Texas A&M Rural and Community Health Institute, stresses the urgency of exploring new payment models in collaboration with rural providers. "If we don't pioneer alternative payment methods and craft a new payment landscape together, access to healthcare may not withstand the test of time," Davis argues. She believes in the power of synergy among providers, payers, and innovators to pilot payment schemes that are a perfect fit for the unique needs of rural healthcare, ensuring its ability to continue delivering stellar services.

Forging partnerships with tech companies, government bodies, non-profits, and other healthcare systems presents a viable path for rural healthcare entities to navigate the murky waters of reimbursement and technological hurdles.

According to Davis, the diversity of circumstances across rural healthcare providers means there's no one-size-fits-all answer. It's crucial for these organizations to collaborate, allowing them to stay on the cutting edge and ensure that rural healthcare doesn't get left in the dust.

Adopting a value-based care approach appears promising for rural health providers, but as Davis points out, the relatively low patient numbers pose a significant challenge. A potential strategy is for health systems to band together, forming clinically integrated networks that can amplify patient volume, thereby wielding greater influence and efficiency.

In rural healthcare, getting doctors credentialed is like running an obstacle course with extra hurdles. This process, essential yet intricate, consists of around 52 meticulous steps before a physician's paperwork is even ready for review.

Any slip-up in this complex procedure can lead to serious consequences, including the nightmare scenario of unqualified doctors treating patients. The journey through credentialing includes tasks such as distributing and collecting detailed provider application packets, scrutinizing past medical malpractice claims, and verifying all manner of documents from government IDs to professional licenses. Not to mention, an exhaustive 10-year criminal background check and a deep dive into the National Practitioner Data Bank are part of the drill.

Why Does Credentialing Matter So Much?

Credentialing sits at the heart of a healthcare provider's ability to operate efficiently. It's the gateway for physicians to join health plans and bill for their services. When this process hits a snag, it doesn't just disrupt the doctor's workflow; it shakes the entire revenue cycle of a healthcare setup. This issue hits rural America especially hard, where resources are scarce, and every hurdle feels magnified compared to urban healthcare centers.

The credentialing process isn't quick—it can stretch from 90 to 120 days, demanding both money and manpower. Rural health organizations often struggle with the resources needed for such a detailed task. Ideally, a credentialing specialist, with a salary expectation of around $72,725 annually, would take charge. However, the financial strain of hiring a specialist, on top of other costs like software and application fees, puts this out of reach for many rural health facilities already tight on funds. As a result, these organizations face a catch-22: without credentialing, they can't bill insurers and generate revenue, but without revenue, they can't afford the credentialing process.

This vicious cycle leaves rural healthcare providers in a bind, struggling to find a way through the credentialing labyrinth. It's a challenge that demands not just diligent effort but also a stroke of luck and perhaps a rethink of how we support healthcare in our rural communities.

Rethinking Credentialing in Healthcare: From Paper to Cloud

Traditionally, healthcare organizations have leaned on manual methods and paper trails for medical credentialing. These approaches, reliant on hand-filled forms and standalone databases, are fraught with challenges:

  • Mistakes, missing pieces, or repetitive data can undermine the credibility of credentials.
  • Paperwork can get lost or damaged, leading to delays in the credentialing process.
  • Sharing or updating information across locations or departments becomes a logistical nightmare.
  • The risk of unauthorized access or loss puts sensitive data at jeopardy.
  • Keeping track of expiration dates or renewals for credentials is an uphill battle.
  • The process eats up time, manpower, and money that could be better spent elsewhere.

These obstacles can compromise healthcare delivery and quality, not to mention the risk of falling afoul of compliance standards or legal requirements due to outdated or incorrect credentials.

A Brighter Future: Cloud-Based Credentialing

Enter cloud-based medical credentialing software: a modern solution that transforms the credentialing landscape. This innovative approach harnesses cloud technology to automate and refine the entire credentialing lifecycle. It simplifies tasks from gathering and verifying data to managing clinical privileges and keeping credentials up to date.

This software connects seamlessly with a range of data sources, from licensing boards and accreditation agencies to the National Practitioner Data Bank. It ensures your credentialing information is current, automatically updating records and notifying you of any impending expirations or issues.

Beyond data management, cloud-based systems offer analytics and reporting tools, helping you gauge and improve your credentialing efforts and compliance.

Introducing Credsy: Your Cloud-Based Credentialing Partner

At Credsy, we're pioneers in cloud-based solutions for medical credentialing, designed to make the process smoother for hospitals and medical facilities. Our platform is packed with features to streamline your credentialing workflow:

  • Online application processing
  • Timely alerts and reminders
  • Digital forms with electronic signatures
  • A secure, centralized database for all your credentialing needs

Our seasoned team has dedicated over 10,000 hours to mastering the ins and outs of licensing and credentialing across different states, with a track record of success in thousands of cases.

Interested in seeing how Credsy can revolutionize your credentialing process? Book a free, no-strings-attached consultation with us. We're here to answer your questions and tailor solutions to fit your specific needs.

Book your Free Consultation Today

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