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Top 4 Proven Ways to Overcome the Challenges in Medical Credentialing Services

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Due to the rising number of patients around the world, medical practitioners have been looking for trained, qualified and certified healthcare professionals, especially physicians and nurses. Therefore, they invest a hefty amount in the process of medical credentialing services. 

Healthcare providers don’t want to compromise on the quality of their healthcare services. Therefore, they prefer to hire staff with a new balance of skills such as Advanced Practice Registered Nurse (APRN), physician assistants, medical technology specialists, and IT experts for integrating and standardizing data from multiple sources.

Credentialing is a time-consuming process that consists of two parts, credentialing and privileging. Credentialing is the verification of qualifications, certifications, work experience, and references of the healthcare providers, nurses, physicians, doctors, etc.  In this process, you have to make direct contact with the primary sources including the university where the healthcare provider completed his/her degree, had their training and residency, to confirm their credentials. Meanwhile, privileging is the granting approval to healthcare providers so they can provide patient care services based on the demonstration of competency. 

Credentialing is a market-driven process, which is necessary to maintain the standards of healthcare quality. Administrators of medical practices face enormous challenges to handle this hectic and complicated procedure in an efficient manner. They should adopt innovative solutions to keep this process on the right track. Because an inefficient credentialing system leads to enrollment and financial issues. 

Do you know which factors affect the medical credentialing services? Here are the solutions of most common challenges every medical practice should adopt to keep this process optimized. 

 

    1. Lack of Staff 

 

It is a fact that the credentialing process requires a dedicated and highly trained workforce because a single person can’t handle this process. But unfortunately, healthcare organizations have a higher staff turnover rate as compared to other businesses. This factor impacts the credentialing as well as other administrative tasks negatively. 

So, it is necessary for healthcare providers to sustain a qualified team to verify the competency and eligibility of medical staff including physicians, nurses, physicians assistants, counselors, psychologists, and every other provider. 

It is the responsibility of your credentialing team to verify the educational qualifications, professional career, training certificates, and licenses, of each and every healthcare provider. Therefore, a workforce is essential to handle and maintain the efficiency of this process. If you put this responsibility to limited staff, the chances of mistakes increases.  As a result, the applications that contain errors are rejected by the insurance companies. Which ultimately delays the collection process. 

Therefore, medical practitioners should hire adequate resources or staff to complete the credentialing process. If you find it difficult to manage an in-house team, you should outsource medical credentialing services to a trusted third party. Because a reliable offshore company holds the well-experienced staff for the credentialing process. He has extensive experience handling everything perfectly without any errors and most importantly in a timely manner. By outsourcing, you can also save a lot of time as compared to in-house services. 

 

    2. Incomplete/Inaccurate Applications

 

The enrollment applications are considered as the main component of the credentialing process. Mostly, the applications are rejected just because of incorrect information about healthcare providers or missing fields, which causes a delay in the completion of this process. So, it is crucial to ensure that accurate ad provider data is entered into the credentialing system. 

Healthcare organizations should stop using manual methods to process the enrollment applications of physicians. Because the traditional methods, that totally relies on human-interference, always leave room for mistakes. Therefore, credentialing experts suggest that you can overcome such issues by adopting high-tech solutions. Administrators of healthcare organizations should invest in advanced credentialing based software. Because the automated process reduces human interference and eliminates errors which saves your time and resources.

 

    3. Meeting Deadlines

 

Have you ever thought that a delay in medical credentialing services can slow down your revenue cycle management? It’s a time-consuming process as application review can take up to 90-120 days for an organization to process. 

However, with additional stakeholders, like insurance companies or others, credentialing processing can actually take up to six months. So you should meet the deadlines to avoid any unfavorable consequences and try to start this process on a priority basis. If you find it difficult to manage this process along with the busy schedules of your administration team, you should hire a proficient credentialing company. 

    4. Stay Compliant With Federal Regulations 

 

 

The healthcare industry witnesses constant evolutions in terms of provider credentialing standards and medical services policy guidelines. So it is crucial for healthcare administrators to stay updated with the new rules and embrace the changes as they occur in real-time.  

Medcare MSO is an eminent credentialing company in the United States. Which helps new medical practices and existing healthcare organizations with their medical credentialing services. 

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