Credentialing Roundtable: Credentialing Best Practices 

 

We held a credentialing discussion with four industry experts on the ins and outs of health care credentialing.  Our speakers shared some of their tricks of the trade on how you can avoid dreading expiration dates and overcome the stress that can come with managing providers.

 


 

Did you miss our roundtable discussion? We’ve got you covered!

Watch the full roundtable discussion below and enjoy!

What topics were covered:

  • Best ways to set yourself up for credentialing success
  • How each speaker overcame different credentialing challenges
  • Tips on managing the stressfulness of the job
  • Recommended tools to save you time and money

 

Who Will Benefit From The Discussion:

Current and aspiring practice managers and medical staff interested in learning the best tactics and tools for provider credential management.

 

Who Were The Roundtable Speakers:

Sheli Crabtree

Medical Staff Services Coordinator

Terri Lynn Davis

Credentialing Director

Jodi Hardy

Director of Physician and Patient Relations

Christy Rodgers

Credentialing Coordinator

Questions & Answers from Live Q&A

What do you do when a previous employer refuses to give verification?

Notify and involve the provider. Let them know the file is at risk of being delayed without the response.

Any suggestions to transferring to a paperless system? My office is struggling with committing to going paperless.

My office is struggling with committing to going paperless. – Change is hard! If you are getting pushback, a suggestion is to implement the process on new files going forward vs. trying to retroactively load old files that may not be necessary. Once you get the new process implemented and moving forward, typically the benefits show themselves.

Do you use a specific software or online program to stay organized?

We use our proprietary software for primary source verification and payor enrollment. We also use Sharepoint (Office 365), and Nitro PDF/Signatures to help automate our processes. Another great online tool for credentialing is Ready Doc, from Intiva Health. The software offers a secure “safe” to store verified, digital documents that can be shared with any facility and expedite the credentialing process.

When hiring new credentialing staff, any tips for identifying the best?

Determine how much experience you need. For example, do you have a highly skilled staff that can take on someone who is new to credentialing and train/mold them to your process or do you have no existing staff and need someone with several years of experience? Ask questions that are “broad”’ and see what kind of terminology they use to respond. It is usually a good indicator if they can give you the detail without prompting. Also, be sure you are checking with *professional* references vs. personal references. Determine their relationship (supervisor, co-worker), how many years they worked together and how recently they worked together.

How do you deal with Locum Agencies and getting all the information you need in a timely manner?

Building a relationship with the agency will go a long way. Ask the agency if they can identify one point of contact to help you gather the information you need. We have found that having that point of contact that is identified as “responsible” by the agency, holds someone accountable rather than being passed around. They want the providers credentialed quickly and are usually willing to help!

How do you get malpractice insurances to respond?

We have difficulty getting responses and getting routed to one person than another. – Request the actual Certificate of Insurance during your document collection from the providers where possible or if that proves difficult, only request for the ones you are having issues getting a response from. There is often an email/phone/fax and direct contact listed on the certificate that can help you get the responses you need, vs. calling the general phone line for the company. Build yourself a list of those contacts for future reference!

We have a physician joining our practice that participates in a different state and accepts insurances we are not par with. I have reached out to those insurance companies and they claim their market is closed and are not accepting new applications. How do you handle a situation like this?

Have you been able to get your physicians credentialed based on the other provider’s status, like “grandfather” them in? – It really depends on the situation. Who holds the existing contracts and was there a bill of sale of that practice or are you just adding the provider to your TIN? Sometimes crossing state lines adds additional challenges, knowing how and who to properly appeal to is valuable under these circumstances.

How early do you submit re-credentialing requests?

Six months ahead of the committee date that the file needs to go to is a good place to start. You have to account for slow/no response. I would also suggest giving a deadline to return those files and enforcing those as much as you can. Allow yourself time to process the file (send and receive requests) without cutting it close to the deadline.

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