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The Value of Credentialing: More Than Just a Piece of Paper

Credentialing is the formal process healthcare practices use to verify the credentials of medical professionals they are looking to hire. When checking a medical professional’s credentials, healthcare facilities examine their education, training, licensure, and experience. Checking these credentials can help healthcare facilities hire qualified medical care providers. Here are some of the reasons credentialing services in the healthcare sector are valuable:

Protect Patients 

When patients visit a healthcare facility, they are trusting the doctor to provide them with the care they need without putting them in danger. Because patients may be unable to access doctors’ credentialing information, healthcare facilities are responsible for credentialing their providers and prioritizing patient safety. 

Medical credentialing services can determine whether a healthcare practitioner has had past malpractice claims or other disciplinary actions. A provider can be excluded from working in the medical field after credentialing due to discoveries such as a criminal record or letting their license expire. Credentialing adds transparency to the hiring process and helps assure healthcare administrators that the providers they hire won’t endanger patients.

Medical professionals may also undergo a performance and competence review conducted by a doctor as part of the credentialing process. They may also be asked to submit written peer reviews that attest to their competence. All these requirements further contribute to patients’ safety. 

Protect Healthcare Organizations 

Healthcare organizations can sometimes face patient endangerment lawsuits despite following patient safety regulations. During these lawsuits, the justice system may consider the certifications and accreditations of the organization and the staff members involved in the case. They may also ask questions about the organization’s vetting processes before hiring the involved medical staff. This is where credentialing can protect a healthcare organization and put it in a favorable position during potential lawsuits. 

Credentialing helps prevent the court from discovering that medical providers are excluded from the field or have disciplinary records. This protects the healthcare organization from losing the suit and suffering reputational damage. Credentialing services provide protection from negative repercussions in the event of legal action against a healthcare organization. 

Relieve Healthcare Organizations’ Administrative Burdens

Completing the credentialing process for one job candidate can take months, as it requires the administrative team to gather and analyze a lot of information. The credentialing process can involve large amounts of paperwork and many back-and-forth calls with various institutions. All these activities can take up the time of administrative teams and potentially delay the hiring process. 

Hiring a professional credentialing service can help ease the burden on administrative teams by covering all aspects of the verification process. Working with a Credentials Verification Organization can help healthcare organizations save time and money while thoroughly vetting their job candidates. 

Increase a Healthcare Organization’s Earning Capacity  

Healthcare organizations and practitioners earn money by partnering with health insurance companies. Many insurance companies require organizations to complete the credentialing process before these contracts can be finalized. Some insurance providers only cover healthcare facilities that employ fully credentialled practitioners. When healthcare organizations meet the credentialing process, they open themselves up to a greater number of patients they can treat and receive insurance payments for. 

Healthcare practitioners with all the necessary credentials are legally allowed to treat patients with any insurance plan. When a healthcare organization hires a fully credentialed practitioner, they can cater to more patients, improving their earnings. 

Prevent Revenue Loss

Properly credentialing medical staff may be necessary to comply with federal and state regulations. This can help healthcare organizations avoid incurring fines. It can also protect them from losing insurance payments. If an excluded nurse or doctor treats patients covered under Medicaid, Medicare, or other commercial insurance providers, the insurance agencies may refuse to reimburse the organization. 

Suppose an insurer has reimbursed the healthcare facility and later finds out that a non-credentialed practitioner treated the patient. In that case, the facility can be fined or be required to repay the reimbursement in full. Credentialing can help organizations avoid such instances and protect the facility’s revenue cycles. 

Get Professional Credentialing Services 

Credentialing can be an extensive process when you want to verify several medical staff members simultaneously. Hiring a professional credentialing service can help ease your administrative burden and protect your organization and patients. Professional credentialing service teams can help you save time on information verification and medical practitioner credentialing to make your hiring process more efficient.

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