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Six Common Mistakes Healthcare Practices Make During Credentialing

Medical Billing

Healthcare credentialing is a very time consuming process. It constitutes several complex steps that must be done the right way or could result in huge financial losses. Not just that, there could also be other legal complications that could put the entire healthcare organization in jeopardy. Processes like enrollment, compliance, planning, and such must be done with complete authenticity and clarity.

However, healthcare practices tend to slow down the credentialing process due to a lack of knowledge or expertise. Let us dive into the six most common mistakes that practices make which bring down their efficiency and revenue streams.

1. Time management & planning errors

Credentialing process constitutes numerous data verification that could take up to four months to complete. Getting prepared for the application is yet another time-consuming process that requires collection and verification. So, having proper planning for the entire process to be more efficient and streamlined is indisputable. Many times, this is where the practice staff lags, which radically impacts both the provider and facility.

As for the healthcare provider, credentialing entails having to wait longer to begin treating patients to deliver services. This means the doctor risks losing crucial time in the process.

The facility must hold off until a new doctor comes on board who is credentialed. If not, they will not receive the required reimbursements for the services rendered, thereby resulting in huge revenue losses. Not having enough resources and planning issues lead to such scenarios.

2. Errors in data entry

Data that needs to be processed for credentialing must be accurate. Lacking accuracy will definitely delay the process. Data entry errors are yet another area where practices make mistakes at large. These could be missing info, typing errors, incorrect documentation, and such.

Missing info: Omission of important information or absence of crucial information stand first under credentialing data entry errors. These occur due to misunderstandings during the data acquisition process or due to a mix-up of several pieces of info.

Typing mistakes: These mistakes are done by staff who enter the information into the system. These are manual errors that need to be rechecked at least twice before processing. Misinformation could be titles, addresses, ID numbers, NPI numbers, etc.

Incorrect documentation: Poor documentation and organization during the entire application procedure create doubt and misunderstanding, demanding repeated resubmission.

3. Application errors

What could go wrong in applications? Well, there could be incomplete applications, delays, issues in tracking application statuses, and incorrect authorizations.

Incomplete application: Information on the application must be filled with all the relevant information, as missing any vital information could result in rejections from the insurance company. Most of the time, practitioners fail to update their complete career history, right from their first license to the current status. Failing to deliver a complete application could affect their career line.

Delays: Another situation when the entire procedure gets stalled in the middle is when questions from the authorities on the application are handled slowly. These queries may be responded to after a delay, go ignored, or unanswered due to the tightly packed daily activities for clinic staff.

The issue in tracking application status: Chances of the application getting halted in the process are high, especially when the insurance company handles a large number of clients and has barely any time to manage everything. This could lead to issues in tracking and follow-ups which impacts the revenue streams.

Incorrect authorization: Applications may get rejected if they contain serious credentialing errors, such as the absence of the relevant signature and attestation from the required authority.

4. Compliance errors

The requirements and guidelines for credentialing vary from state to state. Healthcare practices must ensure that they meet all the requirements for healthcare credentialing for the state that they are in. These errors occur due to several reasons including:

Staff ignorance: It always takes a well-trained staff to get the credentialing process right. Assigning other staff could only result in errors that will demand a well-informed person to rectify.

Failing to adhere to the accepted regulations: Credentialing criteria also varies from one insurance company to the other. Failing to stay compliant with the specifications will only stretch the entire process and result in critical time wastage.

No knowledge of specialty-specific particulars: Not having enough experience to differentiate various specialties is yet another aspect where compliance errors for credentialing occur. During the credentialing process, in addition to the regular requirements, specialized documents proving expertise in the specialist practice are needed.

Ignorance of the potential consequences of the law: The practice staff working on the process might not have any knowledge about legal consequences that the practice could face due to the error in compliance. It is always important to educate the staff on the legal implications or to hire the right person who knows what they are doing.

5. Errors in the enrollment process

The enrollment process is associated with the payment and billing process. Hence, when errors occur in enrollment, it gets directly reflected in the revenue cycle efficiency. The common mistakes in the enrollment process happen due to the following reasons:

The application process not adhering to the insurance company requisites: Each insurance company sets out distinctive rules, protocols, regulations, and such, which need to be considered by the practices before enrolling. This is a very common credentialing error that practices make as they fail to comply with the requirements (due to lack of knowledge).

Not being familiar with the local insurance providers: Connectivity with insurance providers is the foremost thing that practices must look into as they set up their facility. When new to the state, it gets hard to find and have good knowledge about the payer companies.

Neglecting to assign staff for query clarification (from the insurance company): Insurance companies might have queries regarding the application or the processing details even before the enrollment process. So, it is necessary to assign personnel who solely respond and suggest solutions for insurance companies. Failing to do so will delay the entire payment process.

Loss of Revenue: Whatever may be the reason, delaying hiring a practitioner in a facility will only bring down their revenue flow.

6. Errors due to no digital assistance

Credentialing necessitates comprehensive paperwork that could get really tedious. It could become almost impossible to keep up with it unless there is some kind of digital support. The lack of digital assistance could lead to errors including:

Not updated with the credentialing process: New regulations for credentialing process are constantly updated. It might become too much for practices to ensure state-of-the-art authenticity where they must conduct re-evaluations in proper periods.

Errors that happen due to timeliness of application: Deadlines are difficult to meet when the process is carried out manually. It’s also challenging to re-access the records when necessary, not to mention the accuracy errors.

Not renewing credentials and licenses: Clinical activities are tightly packed, so it is only natural for practitioners to forget about renewing license and credentials. This could be a huge problem while applying for the credentialing enrollment process.

Final Thoughts

In order to stay away from all these errors and oversights, it is important for healthcare practices to consider measures like outsourcing, digitizing, and hiring skillful resources. Expertise in managing the entire credentialing process is what they should focus on. However, managing all the clinical activities can get really frustrating. Practolytics could serve you as your credentialing partner. Our well-experienced experts are focused on giving out the best possible accuracy in credentialing before sending them out to insurance companies.

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Practolytics partnered with AdvancedMD in 2013 to create a one-stop solution for all the medical billing, practice management, patient management, and revenue cycle management activities a healthcare practice need to carry out. A Platinum partner amongst 850+ billing companies, Practolytics is a 20+ year-old healthcare technology and revenue cycle management services company providing medical billing service solutions to 180+ practices of all sizes spreading across 31 states and serving more than 28 critical specialties. Practolytics with support from AdvancedMD billing software processes more than 2.5M claims annually, collecting more than $500M for its clients. End-to-end services include medical billing, medical coding, chart audit, credentialing, eligibility, benefits verification, and preauthorization services. The company’s diverse background in every aspect of healthcare allows it to maximize revenue and consistently deliver optimum results.

Topic: Medical Billing

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