10 Reasons Why Medical Credentialing Is Important

By bogotapost June 5, 2019

Medical credentialing is an important process for both the patient and the doctor. Find out why it’s so important with these 10 facts.

Medical credentialing refers to the process by which healthcare organizations, insurance networks, and hospitals assess and confirm the qualification of a healthcare professional.

The process is important for both the patient and the doctor as it ensures that practitioners who are providing care are qualified to do so.

Find out why credentialing is so important with these 10 facts.

1. Medical Credentialing Improves Patient Trust on Chosen Healthcare Provider

Trust between medical professionals and patients is a prerequisite in the health care system. Trust enables patients to open up and disclose information courtesy of their perception of better care and greater acceptance to recommended treatment.

Patients who know little about their doctor’s qualifications are less likely to put their full trust in the doctor. Assessing and confirming the qualification of hospitals and healthcare agencies assures patients on healthcare professional’s merit and experience, thus allowing them to place their trust in their chosen providers.

2. Prevent Healthcare Organizations and Hospitals from Losing Revenues

For any medical office, it is necessary that they partner with insurance careers. Physicians and other healthcare professionals are required to produce a list of verifications to insurance if they are to be considered for reimbursement expenses.

Failure to obtain proper credentialing by healthcare professionals can result in insurance carriers not reimbursing medical offices that bills for the professionals. In the event that a medical office allows a professional to perform services prior to credentialing, the insurance carrier can backdate the reimbursement of the medical office to cover services offered.

However, since the timeframe has a limit, the medical office risks losing thousands of dollars that may not be recovered from the insurance payer.

3. Lowers the Risk of Medical Errors

It is estimated that every year, about 98,000 Americans die from medical errors. This worrying statistic compels industry leaders to campaign for improved standards of competency and exposure to disciplinary actions against healthcare workers.

Credentialing healthcare providers, more so independent practitioners, help reduce the risk of medical errors that may be caused by incompetent providers. Furthermore, since electronic credentialing employs automation tools, there is no room for human error or fatigue that is associated with the manual evaluation process.

4. Fewer Restrictions

Healthcare credentialing has widened the scope of services offered by insurance plans with fewer restrictions on pre-existing conditions now evidenced. As of day, no insurance company is permitted to deny any person coverage, charge a person more, or deny payment on vital health benefits that surrounds pre-existing conditions. This has helped prevent patients from seeking services of specialists who are out of work.

5. Ensures the Doctor Remains Fit Within the Network

One of the key roles of credentialing involves the evaluation of a health professional’s history and practice. Normally, the process is completed before a professional is allowed to join a network. However, it does not end there. The insurance provider may continue to review the credentials on a routine basis to confirm the professional’s fitness to remain within the network.

6. Improves Practitioner’s Business

Medical credentialing allows medical practitioners to accept patients that possess health insurance. Currently, the majority of Americans have health insurance plans. The practitioner, thus, boasts increased clientele.

It is also ostensible that most patients favor meeting the same physician again and again. Physician credentialing will, therefore, result in recurring patients which, in turn, improves the practitioner’s business.

7. Improves the Reputation of Health Practitioners

With more patients now researching about their healthcare professional prior to committing to them, it is vital that healthcare professionals manage and take control of their online reputation to be able to retain their clients. One of the important steps that professionals can take to improve their reputation is by undergoing medical credentialing.

A practitioner who has undergone this process is permitted to treat all patients regardless of their insurance plans. Since the practitioner can handle a diverse range of patients, s/he will most likely earn a reputation from every corner of the world.

8. Protects Healthcare Organizations from Potential Lawsuits

In many states, there exist laws that require credentials on legal documents like prescription and medical records. These laws also cover professional activities including legal testimony, speaking engagements, and research publications. Without proper credentialing, the hospital may miss on significant things required by the law.

Credentialing ensures that a healthcare organization adheres with the letter of the law. The process allows clinics to register to perform the National Practitioner Data Bank queries which allow them to have a look at the malpractice claims history of their providers. This allows them to practice safely and legally going forward.

9. Cost Savings

With the current strains in the healthcare budget, healthcare organizations are under increasing pressure to lower their costs of operation and streamline hospital processes. Electronic credentialing allows these facilities to migrate from a paper system to a cloud-based computing solution, thus lowering costs without affecting the health and safety of people.

10. Used by Medical Providers and Medical Groups as Part of the Hiring Process 

The process of credentialing involves thorough examination that evaluates the qualifications, career history, and proven skills of a health professional including their education, licenses, residency, and training.

This process is generally performed whenever a new doctor or physician is hired to ensure that the professional a health care provider end up hiring is completely qualified for the position.

Furthermore, the credentialing process is required by insurance companies to allow the provider to operate within the network. Professionals that are hired are thus required to abide by the standards set by accreditation organizations, and medical governing bodies. For more information on how to speed up provider credentialing, check out this credentialing software.

Wrapping It Up

Medical credentialing is increasingly becoming important in healthcare as healthcare organizations look for ways to ensure greater patient safety, reduce costs, as well as protect healthcare institutions from harm.

Assessing and confirming the qualification of healthcare professionals can save healthcare organizations from a number of liabilities, including fiscal loss, incompetent healthcare providers, risk of compliance violations, and unwanted lawsuits.

In order to have a solid patient base, a healthcare professional should consider being credentialed with many insurance providers.

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