If you poll credentialing professionals, you will learn that the primary causes of delays in the provider credentialing process are (a) incomplete applications and (b) delays in turnaround for peer reference evaluations.
After more than 30 years as a medical staff services leader and credentialing veteran, I’ve seen many changes, starting with the Joint Commission’s more stringent standards for credentialing and privileging in the 1980s. Back then, if your job entailed the processing of credentialing applications for medical staff membership, it’s likely you were still pecking away on a manual typewriter and sending referencing requests via regular post.
Today, we can enter and access data any time, from anywhere using a myriad of devices. Yet, the standard turnaround time for completion of an application for Medical Staff membership or managed care plan enrollment still takes on average 90-120 days, and sometimes even longer.
The internet has made the collection and verification of most of the required credentials (licensure, education, professional liability insurance coverage, criminal background, sanctions, DEA, NPI number, etc.) almost instantaneous.
What slows down the credentialing process?
It’s when you get to the peer references that the slow-down begins. There have been some changes that have helped; for example, we’re now using credentialing software to automate the transmittal of documents via fax and email. But the process is still somewhat manual in that the peer references have to complete a paper questionnaire that either comes via fax or must be printed from an email attachment. This form completion typically requires that the peer references are physically in their offices. After the forms are completed, the peer references or their staff must get those completed questionnaires back to the requesting entity. Second and third requests as well as follow-up phone calls can be required in order for the credentialing professional to get the completed forms back in a timely manner.
Technology has revolutionized this process. Envision your peer references being able to review requested privileges and complete your questionnaires at any time of the day and at any location that is convenient to them…on their mobile devices. Once the form is completed and signed electronically –typically within 5 minutes — that completed document is immediately accessible online in the credentialing department. This is the basis of the dramatic reduction in turnaround time for peer references.
The high cost of delays
The cost of just one month’s delay in credentialing the average primary care physician can amount to over $30,000 in lost revenue due to the inability to bill for services. For a hospital hiring 50 primary care physicians annually, such a delay can cost over $1.5 million. Consider what these amounts add up to for higher-billing specialties.
With the increase in need for credentialed providers (physicians and, ever more increasingly, nurse practitioners and other “physician extenders”) and the reduction in the number of full time employees healthcare organizations can devote to the credentialing process, it becomes more vital now than ever to embrace the benefits of the Internet to truly automate the credentialing process.
Tapping into online and mobile solutions
SkillSurvey is working with healthcare leaders and credentialing professionals to pinpoint ongoing opportunities to improve the credentialing and privileging process with SkillSurvey Credential OnDemandTM. I’m proud to be part of bringing this next evolution to the world of credentialing. By moving the process online, and providing customizable online and mobile accessible forms that allow for electronic signature, we’ve reduced the average turnaround for peer references to typically 3-4 days, beating the current industry standard of 4-5 weeks.
By reducing credentialing delays, a hospital or other healthcare organization can more quickly make a determination as to the granting of clinical privileges to the applicant and begin the onboarding process. This facilitates a more timely credentialing process for physicians or nurse practitioners applying for health plan enrollment, which requires hospital privileges. Less time spent in the credentialing process means a faster start-up for seeing patients…and physician satisfaction.
Linda Van Winkle is Director of Product Management at SkillSurvey. Prior to SkillSurvey Linda was Manager of Medical Staff Services at CHRISTUS St. Patrick Hospital in Lake Charles, Louisiana. Ms. Van Winkle developed a credentials verification organization, CHRISTUS Credentials Plus that achieved CVO certification status by the NCQA. She achieved CPMSM and CPCS certification and is a member of the National Association of Medical Staff Services.