CREDENTIALING REVIEW

Credentialing, as discussed in the first blog of this series, is the process of gathering and verifying professional information about a prospective healthcare provider. This includes information such as education, licenses and professional designations, work experience and references as well as tracking professional disciplinary history. Credentialing helps to ensure patient safety by making sure they receive competent care from qualified providers. Anyone who has dealt with the recruiting and hiring process knows that verifying and keeping track of credentials is not only time consuming but can also be very overwhelming. So it’s only natural that a need for a more efficient process has emerged, especially in our day and age of instant gratification. In response to the need for a faster, more efficient way to submit credential applications, track and update data, theCouncil for Affordable Quality Healthcare (CAQH), a coalition of national healthcare plans and networks, worked to streamline the credentialing process with the development of a common secure application database. Such a centralized system makes it easy for HR managers and recruiters as well as providers to add or change information, such as adding or changing professional designations.

THREE COMMON METHODS FOR HEALTHCARE CREDENTIAL MANAGEMENT

Healthcare credential management is a universal requirement for all organizations hiring practitioners. Everyone has to do it. However, the larger the practice or healthcare organization, the more necessary it is to have a plan to track and update physicians and other credentialed providers, from the initial credential applications to post-hiring periodic updates as required by CMS, JCAHO and other agencies. How complex a plan may need to be depends largely on the size and scope of the organization. While many aspects of the process are common to all prospective providers, it is much easier to keep track of updating the credentials of just a few providers than dozens, especially if varying specialties are involved. So how do other organizations handle this complex and daunting process?

There are currently three models currently in use for managing credentials of potential new hires.

The first method is often used by small organizations with few resources. This method involves everyday computer software, such as spreadsheets and Microsoft Outlook to organize payers, providers and third parties and keep track of potential candidates as well as their credentials and schedules. While this method might have been adequate several years ago, it’s now quite archaic. The two biggest problems with this method are that it is time consuming and mistakes are easily made, since it’s a manual process. The specialist must also pay close attention to providers whose certifications are expiring, risking compliance issues. The process is cumbersome and difficult to share.

A second method for managing healthcare credentialing is outsourcing the process to a company that only does credentialing. This places the entire process of verification of education, training, licensure and certifications all in the hands of a third party. While most of these third-party credentialing organizations utilize the CAQH in this process, a main drawback to healthcare organizations, big or small, is the time involved in using their services. Because third-party credentialing organizations become a middleman between the hiring entity and the institute where a candidate’s credentials are verified, the verification process can be long. One of the fallouts is that the hiring entity must plan ahead and begin the credentialing process a minimum of 45 days before hiring, or a candidate may not be covered under insurance. This leads to organizations not getting paid by insurance companies and also risking legal action if a candidate fails to check out. Plus, an outsourced, third-party solution can be very expensive.

This brings us to the third method, a solution that works to take the headache out of the credentialing process. Since the advent of new healthcare management software and other technologies, submitting applications and tracking updates is no longer quite as time-consuming nor  involving as much  paperwork. Now just about anyone can use the newer, user-friendly cloud-based technology to submit, track and update credentialing data. However, not all cloud-based systems are the same, and a few key features are important. Because providers must constantly consider recruiting based on credentialing, so using a system that allows them automated processes and notify them when needs arise to fill positions allows for agility in hiring. Cloud-based systems give providers access to applicants who already have verified credentials and can move much more quickly into a temporary or long-term position that needs to be filled.

WHAT DOES A QUALITY SOFTWARE APPLICATION DO.

A quality software application not only provides credentialing and compliance but also incorporates a multitude of specific recruitment processes. 

1. Entire recruiting process.
2. Searching and matching based on credentials and compliance
3. Tracking the validity of credentials
4. Automated verification of credentials
5. Notification to the candidates on credentials that are required, expired or pending reverification.
6. Automated checkpoints to avoid wrong hiring which can save all the issues related to non-compliance and also reduce chances of errors.

Good cloud-based systems also integrate recruiting, competency testing and compliance management by automatically notifying a provider when an employee is nearing non-compliance. They also integrate invoicing and payroll, so compensating temporary workers and contract employees is a streamlined process. There are several companies who offer this type of service. However, exceptional cloud-based systems integrate credential and compliance management, payroll and invoicing with scheduling, all on one complete system. They offer customizable applications and they have the process to adhere to the requirements of CMS, JCAHO, and other credentialing agencies. A seamless application minimizes paperwork and reduces administrative tasks, saving time and money for the healthcare enterprise. At the other end of the spectrum, candidates are saved from overwhelming paperwork enabling them to better focus on patient care than administrative wrangles. As you can see, credentialing can be a complicated process. And just when you thought it couldn’t get any more complicated, our next blog will talk about compliance, an important aspect of healthcare credential management. But don’t worry, we’re also going to show you some ways to help manage this process so it doesn’t leave you befuddled. Knowledge is power, as they say, and having an in-depth perspective on all the procedures and regulatory requirements ensure you can find a single solution which effectively addresses all the loose ends. Stay tuned as we make your passage through the credentialing journey, a little bit more interesting and in-depth with a view on compliance in our next blog.

Sources:

http://www.caqh.org/

https://www.jointcommission.org

http://www.hcasma.org

https://www.anthem.com

http://bphc.hrsa.gov

About TargetRecruit: With a globally-connected presence, TargetRecruit’s creative and innovative solutions have helped healthcare companies like AMN & Medpro manage their recruiting, staffing and sales operations. Targetrecruit featured on the INC 5000 2016  list of the most successful and fastest growing businesses in America. Meet them at Dreamforce’16 , SanFrancisco, Booth 2145.

About the author : Reena Gupta is the founder and CEO of TargetRecruit  and its parent company Avankia. Reena was selected for CRN’s ‘Women of the Channel’ 2016, 5th time in a row.She also featured in Insight Magazine’s 50 most empowering women in business.