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Top Mistakes Physicians Make in the Credentialing Process

Physician credentialing is a process whereby a doctor's career history is thoroughly reviewed. This typically involves examination of the doctor's education, licenses, certifications, as well as practice history. It is a requirement prior to the hire of a doctor to a new practice or hospital. Physician credentialing is a time and labor-intensive process, usually taking an average of ninety days to complete if there are no hiccups.

Successful physician credentialing involves thorough planning on the part of the doctor in order to prevent issues that may hinder the review process or even lead to outright rejection. It is advisable to employ the services of professionals to facilitate this process and avoid pitfalls. Discussed below are some of the top mistakes made by physicians during the credentialing process due to lack of knowledge or foresight.

Late start to preparation

As previously mentioned, the credentialing process takes a long time. As such, it is important to start the process as early as possible. Plenty of time has to be carved out to fill out the application forms, compile the necessary documents, and ensure licenses, as well as certifications, are up to date. Not earmarking enough time for these tasks can lead to significant errors in a bid to rush and get everything done.

Incomplete / missing information

Attention to detail is of the utmost importance when filling out the credentialing paperwork. It is essential to provide all the required information as accurately as possible. Failure to do so may significantly hinder the application process. It is a good idea to review the completed application paperwork several times to look for errors. In addition, it may also be helpful to have a third party do a thorough review of the paperwork before submission to the credentialing committee.

Failing to monitor the NPDB

The National Practitioner Data Bank (NPDB) is a national database that collects information about physicians regarding malpractice settlements, judgment, or other negative information. This information is usually made available to the credentialing committee upon request and is a major determinant of whether the doctor passes or fails the credentialing process. As such, it is important for a physician to monitor the NPDB closely; any additional information requested should be provided promptly. Also, erroneous reports should be contested and corrected as soon as possible.

Letting the CAQH lapse

The Council for Affordable Quality Healthcare (CAQH) is an online database that stores all the information needed for the credentialing of a doctor. The CAQH aims to streamline the credentialing process by having the required information readily available to the interested parties and thereby shorten the credentialing time. Some organizations use this means for their physician credentialing process; it is therefore important that the information in the CAQH is kept up to date on a frequent and regular basis. Neglecting to maintain the CAQH can hinder the credentialing process by committees that obtain physician information by this means.

Failure to keep up with government health program standards

Most credentialing processes require that the doctor be registered with various government supported health programs such as Medicare and Medicaid. The registration processes for these programs vary and errors can be made out of ignorance when trying to register for these programs; these errors can lead to a delay in the physician getting credentialed. To minimize the chances of error, it is advisable to use the services of specialists who are well versed in the nuances of government health programs.

Ultimately, the best way to prevent mistakes that can hinder or even derail the credentialing process is to utilize specialists familiar with the entire process. At Hendershot, Cannon & Hisey, we have skilled lawyers willing to work with you to streamline and speed up your credentialing process. Contact us today for more information.

Sources

http://www.physicianspractice.com/blog/national-practitioners-data-bank-what-physicians-should-know

https://www.seak.com/blog/uncategorized/10-biggest-legal-mistakes-physicians-make-credentialing-process/

http://providerenrollment.support/caqh-credentialing/

http://www.e-mds.com/top-4-credentialing-mistakes

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