The Financial and Operational Impact of Credentialing Errors

Healthcare provider credentialing ensures that a provider is appropriately qualified and authorized to deliver medical services to patients. Though the credentialing process is intricate and time-consuming, it is essential for healthcare organizations dedicated to maintaining high-quality patient care.

Healthcare administrative staff and providers responsible for credentialing may spend weeks or months gathering comprehensive provider data to comply with accreditation standards and prevent costly mistakes. In large health systems with hundreds or even thousands of providers, manually collecting the required information and documentation is an overwhelming task. Without automation to streamline data collection, effectively managing the credentialing process becomes exceedingly difficult.

Financial and Reputational Consequences

Let’s consider the financial implications. Successful credentialing hinges on meticulous attention to detail. When this process breaks down, expenses quickly rise. Rectifying credentialing mistakes requires time-consuming investigations, rework fees, and additional labor costs, all contributing to delays. These delays can lead to lost reimbursements from payers, which can add up to hundreds or even thousands of dollars for filed patient claims.

According to recent data, the average physician generates approximately $2.4 million per year in revenue for their affiliated hospital. This figure can vary depending on the specialty, location, and the healthcare system’s specific circumstances. For example, primary care physicians might generate less than this average, while specialists, particularly in fields like cardiology or orthopedic surgery, might generate significantly more. Poorly managed credentialing can not only result in patient attrition, but additionally, it can harm the patient if the care is delayed or not provided, leading to costly lawsuits for negligent credentialing leading to long-term damage to a healthcare system’s finances and reputation.

The Impact on Patient Safety

Verifying that healthcare providers possess the necessary credentials and clinical expertise to perform specific procedures is crucial. Consider the risk of undergoing surgery with a provider who has limited experience with the procedure. Errors in granting privileges can lead to severe patient harm or worse.
Developing and maintaining privilege delineation forms that align with evolving industry standards is a complex, labor-intensive task requiring collaboration and continuous research across various specialties. To safeguard patient safety, ensure clinician satisfaction, and have an effective revenue cycle process in place, it is vital that providers are accurately and promptly credentialed and granted privileges.

In today’s healthcare environment, a refined privileging process is indispensable for both patient safety and effective revenue management. By utilizing credentialing technology to streamline and integrate processes – from privilege applications and provider profiles to consumer lookups – healthcare organizations can save time, reduce costs, and achieve fully integrated electronic privileging.

Enhancing Clinician Satisfaction

Credentialing and re-credentialing are labor-intensive and time-consuming processes for providers. Filling out forms, uploading documents, and answering detailed questions can consume hours, detracting from patient care, reducing revenue, and contributing to provider burnout.

For healthcare administrative staff and providers, an inefficient credentialing process can lead to errors, which can harm morale. These professionals strive for excellence and expect their organizations to uphold the highest standards of quality.

By implementing clear policies, procedures, and a quality assurance program designed to catch errors before they become costly, hospitals and health systems can create a win-win situation for everyone involved – physicians, staff, patients, and the organization as a whole.

Minimizing Credentialing Mistakes

While credentialing errors are inevitable, proactive measures can minimize their occurrence. Utilizing credentialing and privileging software automates the process, streamlining the entire provider lifecycle, from initial application to performance monitoring.

Automated credentialing technology simplifies data gathering, secure access, reporting, and ongoing compliance, reducing the burden on providers, credentialing staff, and approval committees. Hospital systems using such technology have reported significant reductions in credentialing timelines.

The right software helps manage the credentialing process efficiently, ensuring that all aspects are verified and providing timely notifications when licenses or certificates are due to expire. Additionally, integrating credentialing with privileging ensures providers are properly vetted, minimizing patient harm and associated risks.

Let TriumpHealth Help You

TriumpHealth credentialing team helps healthcare providers and organizations in proactive planning and management to navigate the credentialing process successfully. With significant due diligence, we lay the groundwork for your thriving and enduring healthcare organization or medical practice. Feel free to contact us at sales@triumphealth.com or call (888) 747-3836 x0 today to learn how we can make this process easy for you.