Running a healthcare practice isn’t easy. You have to take care of a number of things including quality of patient care, medical billing, revenue cycle, and provider credentials verification. In today’s blog, we will be discussing everything about the medical credentialing process like what medical credentialing is, how it works, and how long does medical credentialing process take. Moreover, we will discuss why medical credentialing is critical for a healthcare practice.
Understanding the process of medical credentialing and its duration is very important for healthcare professionals and practices. So no matter if you are a physician, nurse practitioner, or any other healthcare professional, by the end of this blog, you will be able to know everything about the medical credentialing process.
So let’s start.
What Is Medical Credentialing?
Medical credentialing is the process in the healthcare industry that verifies and evaluates the qualifications and background of healthcare professionals. The credentialing process helps practices ensure that the physicians, nurses, and other medical providers they are going to hire are eligible to provide quality care to patients.
The medical credentialing process involves a thorough verification of educational documents, licenses, certifications, and work history. This gives healthcare practices the confidence that their healthcare providers are qualified and competent to practice in their respective fields.
What Is The Basic Process Of Credentialing?
1- Submission of Application:
Medical credentialing involves a multi-step process. Initially, doctors are required to complete facility-specific applications, either online or on paper. These applications can vary in length from 10 to over 100 pages.
Healthcare providers must provide comprehensive information about their education, training, work experience, licenses, certifications, and references. The application forms serve as a means for healthcare facilities to assess the qualifications and credentials of the medical professionals seeking privileges to practice within their organization.
2– Submission of Supporting Documents:
The very next step in medical credentialing is the submission of necessary supporting documents. In this step, healthcare providers provide copies of their medical licenses, DEA ID number, insurance documents, board certification documents, educational and work history, as well as health-related documentation.
Moreover, many facilities may require activity or procedure logs to assess your experience and expertise in specific areas of healthcare. The supporting documents play a critical role in the evaluation and verification of healthcare providers’ qualifications and in ensuring that they meet the required standards for practicing.
Soon after receiving the supporting documents submitted by the healthcare professional, the medical staff services office starts verifying various aspects of his/her background. This includes reaching out to organizations and individuals to confirm details such as employment history and educational qualifications.
The verification process helps practices ensure that the healthcare provider they are considering hiring meets the necessary standards and regulations set by the concerned regulatory bodies.
4- Appointment Approval/Disapproval:
It is that stage in medical credentialing where it is decided whether the application will get approved or disapproved. The appointment approval stage usually involves the review of the healthcare provider’s application and supporting documents after verification. In most cases, only the medical staff services office’s approval is required.
In the re-credentialing process, the healthcare provider has to get his/her credentials verified again to maintain hospital privileges. The need for re-credentialing generally occurs after a specific duration, such as every two years.
The provider has to reapply with an application and provide updated documentation to make sure that he/she is still qualified to take care of the patients.
Why Medical Credentialing Is Critical For Healthcare Practices?
Probably the biggest reason why credentialing is important for a healthcare practice is that it helps in ensuring that healthcare providers have the necessary qualifications, training, and experience to provide safe and effective care to patients.
Moreover, credentialing helps practices protect their patients from any such care that is offered by providers who may not be competent or qualified.
Legal and Regulatory Compliance:
Credentialing even helps healthcare practices comply with both legal and regulatory requirements. All insurance companies and government payers require providers to undergo the medical credentialing process so that the practice they are working for can receive reimbursements without any problem.
Another reason why credentialing is considered critical in healthcare is that it helps medical practices in maintaining and improving the quality of healthcare services that they provide to their patients.
By doing verification of the educational degrees, certifications, and licenses of their healthcare providers, practices can ensure that they have competent staff for patient care who are in compliance with healthcare industry standards.
Reputation and Trust:
Medical credentialing enhances the reputation and trustworthiness of healthcare practices. By performing credentialing, practices demonstrate that they are committed to maintaining high standards and ensuring patient safety. Furthermore, credentialing helps build confidence among patients, insurers, and other stakeholders that the practice employs qualified healthcare providers.
How Long Does Medical Credentialing Process Take?
The duration of the medical credentialing process often varies depending on different factors such as the complexity of the application, the efficiency of the credentialing authority, and the responsiveness of the individuals involved. However, the credentialing process generally takes anywhere from a couple of weeks to up to 5 months.
While medical credentialing may seem a lengthy and hectic process, it is essentially important as it ensures patient safety and quality care by verifying the qualifications and competency of healthcare providers.
Therefore, it is crucial for healthcare professionals to plan ahead and gather all the necessary documents and information to make the process faster.