August 7, 2023

AdminRCM

When you are a healthcare provider, you know how important medical credentialing is. It’s the process of verifying your qualifications, education, training, and experience to ensure that you meet the standards and requirements of the payers, hospitals, or other entities that you work with. It’s also essential for your patients, who trust you to provide them with quality care and services.

But medical credentialing is not a walk in the park. It can be a complex and time-consuming task that involves filling out applications, submitting documents, following guidelines, renewing credentials, and communicating with multiple parties. And if you make any mistakes along the way, you could face serious consequences, such as delays, denials, errors, or even legal issues.

That’s why we’ve compiled this list of 10 common medical credentialing mistakes that you should avoid at all costs. And we’ve also included some best practices on how to avoid them. By following these tips, you can save yourself a lot of time, money, and hassle, and ensure that your credentialing process goes smoothly and successfully.

Medical Credentialing Mistakes You SHould Avoid

Mistake #1: Not verifying the accuracy and completeness of the credentialing application

One of the most common and costly mistakes that healthcare providers make is submitting an incomplete or inaccurate credentialing application. This can lead to rejection or verification issues with the payers, hospitals, or other entities that you’re applying to. And that means more work and more waiting for you.

Some of the common errors or omissions that can cause problems are:

• Missing signatures or dates
• Missing or expired documents (such as licenses, certifications, diplomas, etc.)
• Outdated or incorrect information (such as contact details, practice locations, malpractice history, etc.)
• Inconsistent or conflicting information (such as discrepancies between your CV and your application)

To avoid this mistake, you should:

• Review your application carefully before submitting it
• Use a checklist to make sure that you’ve included all the required information and documents
• Attach all the necessary documents in the appropriate format and size
• Update your information regularly and notify the payers or entities of any changes

Mistake #2: Not following the credentialing guidelines and requirements of each payer or entity

Another common mistake that healthcare providers make is assuming that all payers or entities have the same credentialing criteria, processes, or timelines. This is not true. Different payers or entities may have different requirements or expectations for credentialing. And if you don’t follow them, you could end up with delays, denials, or non-compliance issues.

Some of the differences that you should be aware of are:

• The type and number of documents that are required
• The format and method of submitting the application
• The verification process and sources that are used
• The turnaround time and expiration date of the credentials

To avoid this mistake, you should:

• Research the credentialing policies and procedures of each payer or entity that you’re applying to
• Contact them for clarification if you have any questions or doubts
• Submit your application in the appropriate format and manner according to their instructions

Mistake #3: Not updating the credentialing information regularly

Credentialing is not a one-time event. It’s an ongoing process that requires constant maintenance and updates. Your credentialing information can change over time due to various reasons, such as license expiration, malpractice claims, board certification status, practice location changes, etc. And if you don’t update your information regularly, you could risk losing your credentialing status or facing compliance issues.

Some of the consequences of having outdated or incorrect information are:

• Suspension or termination of your credentials
• Penalties or fines for non-compliance
• Audit or investigation by the payers or entities

To avoid this mistake, you should:

• Keep track of the expiration dates of your licenses and certifications
• Notify the payers or entities of any changes in your information as soon as possible
• Maintain a record of all communications and updates regarding your credentialing status

Mistake #4: Not delegating or outsourcing the credentialing tasks to a qualified person or team

Credentialing can be a complex and time-consuming task that requires specialized knowledge and skills. It’s not something that you can do yourself or assign to an untrained staff member. If you do so, you could end up with errors, inefficiencies, or missed deadlines.

Some of the challenges that you could face if you try to do it yourself or assign it to an untrained staff member are:

• Lack of expertise or experience in credentialing
• Lack of time or resources to complete the task
• Lack of attention or accuracy to detail
• Lack of follow-up or communication with the payers or entities

To avoid this mistake, you should:

• Hire a dedicated credentialing specialist or coordinator who has the qualifications and experience to handle the task
• Outsource the task to a reputable credentialing service provider who can offer you professional and reliable support
• Use a software solution that can automate and streamline the credentialing process for you

Mistake #5: Not monitoring the credentialing status and progress

Credentialing can take several weeks or months to complete depending on the payer or entity and the volume of applications. And if you lose track of your credentialing status or progress, you could miss out on opportunities, revenue, or patient satisfaction.

Some of the drawbacks of not monitoring your credentialing status or progress are:

• Missing deadlines or expiration dates
• Missing notifications or updates from the payers or entities
• Missing issues or queries that need to be resolved

To avoid this mistake, you should:

• Follow up with the payers or entities regularly to check on your credentialing status or progress
• Track your application status online if possible
• Resolve any issues or queries promptly and professionally

Mistake #6: Not renewing the credentials before they expire

Credentials are not valid forever. They need to be renewed periodically to maintain your eligibility and compliance with the payers or entities. And if you don’t renew your credentials before they expire, you could face serious consequences.

Some of the consequences of not renewing your credentials before they expire are:

• Deactivation or cancellation of your credentials
• Penalties or fines for non-compliance
• Loss of privileges or reimbursements

To avoid this mistake, you should:

• Set reminders for your renewal dates
• Prepare your renewal documents in advance
• Submit your renewal documents before the deadline

Mistake #7: Not keeping a backup copy of the credentialing documents

Credentialing documents are valuable and sensitive records that need to be stored securely and accessibly. They contain important information about your qualifications, education, training, and experience. And if you lose or damage them, you could face problems.

Some of the problems that you could face if you lose or damage your credentialing documents are:

• Delays or rejections in your credentialing process
• Errors or discrepancies in your credentialing information
• Audits or investigations by the payers or entities

To avoid this mistake, you should:

• Make copies of all your credentialing documents
• Store them in a safe place (such as a cloud service)
• Organize them by payer or entity

Mistake #8: Not communicating effectively with the payers or entities

Communication is key for a successful credentialing process. It involves multiple parties and steps, and it requires clear and professional communication. And if you don’t communicate effectively with the payers or entities, you could end up with misunderstandings, errors, or disputes.

Some of the communication issues that you could encounter are:

• Lack of contact person or information for each payer or entity
• Lack of clear and consistent language and terminology
• Lack of confirmation or acknowledgment of documents received
• Lack of documentation or evidence of conversations and agreements

To avoid this mistake, you should:

• Establish a contact person for each payer or entity
• Use clear and professional language and terminology
• Confirm receipt and acknowledgment of documents sent and received
• Document all conversations and agreements

Mistake #9: Not reviewing the credentialing contracts carefully

Credentialing contracts are legal agreements that define the terms and conditions of participation with the payers or entities. They specify the rights and obligations of both parties, such as reimbursement rates, policies, procedures, etc. And if you don’t review them carefully, you could end up agreeing to unfavorable contract clauses.

Some of the unfavorable contract clauses that you should watch out for are:

• Low reimbursement rates
• Restrictive policies (such as exclusivity, non-compete, etc.)
• Liability issues (such as indemnification, arbitration, etc.)

To avoid this mistake, you should:

• Read the contract thoroughly before signing it
• Negotiate for better terms if possible
• Consult a lawyer if needed

Mistake #10: Not evaluating the credentialing performance and outcomes

Credentialing is not a one-time event. It’s an ongoing process that needs to be monitored and improved. You need to measure how well you’re doing in terms of time, cost, quality, and satisfaction. And if you don’t evaluate your credentialing performance and outcomes, you could miss out on opportunities, efficiencies, or risks.

Some of the benefits of evaluating your credentialing performance and outcomes are:

• Identifying the strengths and weaknesses of your credentialing process
• Implementing changes or improvements as needed
• Ensuring compliance and quality standards are met

To avoid this mistake, you should:

• Measure your credentialing metrics (such as time, cost, quality, and satisfaction) and compare them with your goals or benchmarks

• Seek feedback from the payers, entities, and patients on your credentialing process and outcomes
• Learn from your mistakes and successes and share them with your team

Conclusion

Medical credentialing is a vital process for healthcare providers and patients, but it can also be a challenging and tedious one. That’s why you need to avoid these 10 common medical credentialing mistakes that can cause you trouble. By following these best practices, you can ensure that your credentialing process goes smoothly and successfully, and that you reap the benefits of credentialing, such as ensuring quality of care, reducing liability, and increasing reimbursement.

If you need any help or assistance with your medical credentialing needs, please feel free to contact us at Atlantis RCM. We are a professional and reliable credentialing service provider that can handle all your credentialing tasks for you. We have the expertise, experience, and technology to make your credentialing process easy and efficient. We can help you save time, money, and hassle, and ensure that your credentialing status is always up to date and compliant.

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