Practical Solutions Using Credentialing Software

Healthcare institutions must ensure that credentialing and privileging requirements are met by all healthcare workers.  These vital processes verify that providers are qualified and competent.  Medical bylaws define these minimum requirements. Only hospitals used to perform credentialing in the past, but today almost all healthcare facilities, ambulatory care centers, long-term care institutions, and even urgent care clinics perform credentialing.

What is Credentialing and Privileging?

The formal process of credentialing uses an established series of guidelines to make sure that patients receive the highest level of care from healthcare professionals that have been scrutinized thoroughly to determine their ability to practice medicine.  It verifies that providers’ qualifications, training, licensure, and ability to practice medicine are acceptable.  Additionally, credentialing verifies that all healthcare workers are held to the same standard.

The process of privileging enables a healthcare worker to perform a set of specific patient care services based on an evaluation of the individual’s credentials and performance.  This privilege is a benefit that is not available to all healthcare workers.

What are a few of the challenges in these processes?

For companies with 15 or more providers, credentialing becomes a taxing, time-consuming, and ultimately expensive process.  Let’s take a look at some of the challenges faced in the healthcare credentialing and privileging process:

Problem: Incomplete provider enrollment applications

Solution: The provider enrollment applications are the key to the successful completion of the medical credentialing process. So it should be done in the correct way with all the necessary information. Some practices may fail to do it accurately without missing any data fields which delays reimbursement and potentially denied claims.  Human errors are common in the manual process of filling out provider enrollment applications and forms.  Avoid errors with credentialing-based software that will automate form field pre-population.  Not only does this eliminate errors but also costly time spent entering duplicitous form fields for both your health care workers and administrative staff.

Problem: Maintaining up-to-date information to prove compliance related to licensure expiration and renewal dates.

Solution: Maintenance and access to practitioner information is a common challenge for healthcare organizations. Every provider must be up to date with their board certifications and license renewals.  A good credentialing solution will automate upcoming expiration and renewal notifications to your administrative staff and providers.  Very small changes in renewals, like an address or phone number, must be re-attested in the CAQH database before an application can be processed.  Additionally, allowing providers access to update their own credentialing data and required documentation online can speed up the process.

Problem: Not enough staff resources for verifying credentials.  Verification takes a dedicated team of resources and a substantial time commitment.

Solution: Outsource the complete primary source verification process to a service provider or partially with a credentialing software engine.

What is Credentialing By Proxy?

For telehealth specifically, the Centers for Medicare & Medicaid Services (CMS) issued regulations on credentialing and privileging requirements for telehealth practitioners. CMS Conditions of Participation allow the governing body of an organization whose patients are receiving telehealth services to rely on credentialing and privileging decisions made by a distant site hospital or “telemedicine entity,” such as a behavioral health network or urgent care ambulatory group.  This process is known as “credentialing by proxy.”  Credentialing by proxy helps reduce the time and financial burdens associated with the originating site having to duplicate credentialing and privileging processes.  All sites involved, both originating and distant, need transparency into the credentialing of its telemedicine providers. A hosted credentialing application that provides permission-specific access to administrative staff across various locations is the ideal solution for Credentialing by Proxy.

How can CABEM’s Credentialing Software provide the solution?

With CABEM Technologies you can automate the credentialing process.  Integrate with your existing HRIS or ERP system to automatically onboard providers and manage the credentialing process.  This reduces the time to onboard your physicians and practitioners to get them up running and practicing.  It is designed to be a highly flexible credentialing system with integration options that allow it to serve as a “source of truth” for practitioner information as a standalone solution or as part of a larger ecosystem.  Additionally, it can integrate with DocuSign to manage more complex credentialing requirements such as Collaborative Practice Agreements for APRN’s and Physicians.

In terms of credentialing by proxy, CABEM provides each site access to its own telehealth providers’ credentialing data with supporting documentation to reduce risk and ensure every organization has the level of oversight required.

CABEM’s Competency Manager makes learning accessible to the entire workforce through its many options for implementing blended learning.  With SCORM compatibility and a built-in LMS, the Competency Manager provides a central framework for all your content, no matter the source.  Centralized learning materials allow your organization to stay organized and provide consistency, two essential elements of increasing learner engagement.  Easily import existing training programs, build your own tests and assessments, track attendance, administer guided learning.  Create a learning ecosystem by integrating with your existing LMS or pull-in content from third-party content providers.  With Competency Manager, there is no single right way to offer learning options to your workforce!

Contact us today to learn how our competency management software can help you reduce liability, achieve regulatory compliance, retain talent, and close more business by proving competency. If you would like to learn more, please visit our website and schedule a call today.