What Is Medical Credentialing And Why Is It Important? - Sypore
Medical Credentialing

What Is Medical Credentialing And Why Is It Important?

When a patient visits a hospital to seek care, they expect their well-being and health to be entrusted to a highly qualified and competent healthcare provider. But how can a patient ensure that the provider they are receiving care from is not underequipped or incompetent? This is where the significance of medical credentialing sweeps in.

Medical credentialing is a complex process employed by medical facilities and insurance companies to ensure that only professionals with proper training and experience provide care services to patients. The intricate process involves a thorough review of the healthcare provider’s qualifications, including their education, training experience, malpractice coverage, career history, residency, licenses, and specialty certificates.

Why is Medical Credentialing Important?

Medical credentialing has become imperative for working within an industry where human lives are at stake. The process seeks to maintain the highest standards of quality medical care to reassure patients they are dealing with a healthcare provider who is licensed, certified, and laced with the latest knowledge. In this article, we will be discussing the numerous benefits of undergoing the healthcare credentialing process from the standpoint of a medical facility or healthcare provider.

Lowers Medical Errors and Boosts Patient Confidence

Every year almost 250,000 people in the US lose their lives due to errors in medical billing – making it the third leading cause of mortality in the country (as reported by John Hopkins Medicine). Common medical errors include:

  • Physician-ordered prescription errors
  • Incomplete patient medical records
  • Overcrowded facilities
  • Understaffed clinical areas
  • Mismanaged workflow patterns

The worrying study by John Hopkins Medicine is compelling healthcare industry leaders to raise their criteria and meet improved standards of competency.

In an industry where errors are tantamount to the loss of human life, credentialing becomes paramount for healthcare providers. Credentialing helps support the safety and security of the whole industry by ensuring that only healthcare providers with the necessary skills and experience are providing medical care. According to a recent survey, 26% of healthcare providers agree that appropriate credentials are critical for protecting patients from medical errors and related malpractice.

The average patient in the US is now 10x more aware of safety and security in the healthcare industry than in the last decade. With this increased awareness, patients now demand that their healthcare providers know what they are dealing with and are working in a safe manner. Medical errors can destroy patients’ confidence and deal a death blow to a medical facility’s reputation. Therefore, credentialing is necessary not only for protecting the safety of your patients but also for maintaining a good reputation for your practice.

Most of the errors committed in medical billing services are purely human errors. However, when healthcare providers obtain proper credentials, the risk of medical errors occurring in a medical facility can be lowered as a whole.


Required for Compensation from Insurance Companies

One of the most significant reasons credentialing has become imperative for healthcare providers is because it is now necessary to get reimbursements from insurance companies. Most renowned insurance companies no longer offer reimbursement for services provided by healthcare providers who are not fully credentialed.

The credentialing requirement is not only limited to private insurance companies. Government-owned insurance companies like Medicare and Medicaid also demand to see proof of medical credentialing before they allow any healthcare provider to engage with patients.

Negligence in receiving proper credentialing can result in a loss of thousands of dollars of revenue for your practice from delayed or denied reimbursements. If a medical practice allows its healthcare provider to deliver care services before acquiring the proper credentials, the insurance company may refuse to compensate them and backdate the reimbursement to cover the services. Moreover, healthcare providers that do not acquire the necessary credentials are unable to accept patients covered by health insurance and can only treat patients who pay in cash upfront, resulting in a further loss of potential revenue.

Acquiring credentials is not an easy task in any way, and because of the difference in regulations and credentialing laws, the time frame can vary from state to state. To ensure that you can begin providing services and get reimbursed for them without losing any time, healthcare providers must act proactively and have their documentation set up well ahead of hiring day. By diligently following the credentialing process, healthcare providers can help prevent financial losses from delayed or denied reimbursements.


Helps Maintain Staff Levels

If your medical facility is having trouble maintaining staff levels to serve the local community, put an emphasis on credentialing while filling out your team. Medical credentialing involves a detailed examination of a healthcare provider’s educational background, residential history, work experience, and other merits. It ensures that medical practices only hire professionals qualified for the position and competent enough to perform the necessary tasks in the job description.

New staff members who delay credentialing can pose financial loss to the business and result in understaffing. In most US states, it takes up to five months to complete the credentialing process. Therefore, new medical staff members, especially those not affiliated with a job placement company, should kickstart the credentialing process as soon as possible. Open positions put unnecessary stress on the rest of the team and have a negative effect on the patient experience. Therefore, to prevent delaying onboarding, most medical facilities now demand that new hires have already completed the process before applying. And if they have not, medical facilities provide new hires a credentialing package to streamline the process.


Protects Medical Facilities Against Potential Lawsuits

Credentialing serves as proof that a medical facility and its healthcare providers comply with all state regulations and adhere to the best practices. In most US states, the law requires credentials from healthcare providers to carry out professional activities like publishing research papers or writing prescriptions. With proper credentialing, medical facilities face minimal risks of getting into hot water with the law.

The medical credentialing process also includes a thorough review of any malpractice claims against a healthcare provider. So by having an accurate and detailed record of every healthcare provider’s credentials, medical facilities can minimize the risk of hiring an incompetent provider and protect themselves from potential legal trouble.

While medical credentialing is essential to shield yourself from litigation, there are still circumstances that are out of the control of administrators and healthcare providers. When a lawsuit arises over patient endangerment or negligence, the law reviews your credentials to verify whether your medical facility is in compliance with state laws and meets quality practice standards. If you have all the necessary documentation, you can shield your medical facility from liability and avoid costly fines related to legal disputes.

On the contrary, if the healthcare providers do not have the proper medical credentials, your medical facility will not only lose the lawsuit but also lose its hard-earned reputation – the most difficult loss to recover from.


Expedite the Medical Credentialing Process

Completing the credentialing process can strain your energy and resources as it is a painstaking process involving numerous background checks spanning weeks or even months. Moreover, due to the elaborate and intricate nature of the credentialing forms, even a single mistake can result in a rejected application. To prevent a rejected application and expedite the medical credentialing process, healthcare providers opt to hire a medical outsourcing company.

Sypore is one such company that offers top-notch credentialing and enrollment services to help healthcare providers become part of a recognized network of insurance groups. By taking care of all the tedious paperwork, Sypore allows healthcare providers to sit back and focus on patient care. Our competent field experts, who know all the technicalities of the healthcare industry, make the credentialing and enrollment process quick and easy for your medical practice.

Whether you are an established healthcare provider or a new practitioner, Sypore can help you achieve smooth billing operations and boost profits through a streamlined credentialing process.

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