how to avoid credentialing delays?
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Delegated credentialing is where healthcare organizations outsource components of their credentialing to third parties, such as certified credential verification organizations (CVOs) - PowerPoint PPT PresentationTRANSCRIPT
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HOW TO AVOID CREDENTIALING DELAYS?
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PRESENT SCENARIOToday’s healthcare organizations are consistently getting larger, in terms of the number of physicians within their group or network.
With this growth come additional and time-consuming administrative hassles, such as Provider Credentialing.
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Verifying the credentials of an individual physician can take up to six months.
These delays in the process can lead to lost revenue, unhappy patients, delayed payments, internal referral roadblocks, increases in out-of-network services, as well as coverage and referral issues.
PROBLEMS FACED
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JHBMA ARTICLE
The July/August issue of the Journal of Healthcare Billing and Management Association (JHBMA) featured a cover story titled “Delegated Credentialing for ACOs and Other Integrated Delivery Models.”
The article does a superb job of detailing how provider organizations can potentially avoid these credentialing delays and issues by taking matters into their own hands and implementing a delegated credentialing program.
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ARTICLE INSTANCEDelegated Credentialing is where healthcare organizations outsource components of their credentialing to third parties, such as certified credential verification organizations (CVOs).
However, delegated credentialing is a function that is ideal to be taken on by provider organizations, such as health systems, Independent Practice Associations (IPAs), Accountable Care Organizations (ACOs), and patient-centered medical homes.
Essentially, these provider organizations can credential their own providers by setting up formal delegated credentialing agreements with their payers.
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BENEFITS
Reductions in credentialing process delays.
Physicians are credentialed quicker, boosting revenue and clinical bandwidth.
Information is collected once, and reused for all credentialing processes.
Re-credentialing is simplified.
The benefits of taking on delegated credentialing are substantial, including:
It all seems so crystal clear. Outsourcing credentialing is the way to go.
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DELEGATED CREDENTIALINGHow to create a Delegated Credentialing Program?
Delegated Credentialing is an opportunity for large provider organizations to take matters into their own hands, streamline processes and realize substantial benefits.
These include getting providers credentialed quicker so they can generate revenue and expand clinical bandwidth.
So, how do organizations create a delegated credentialing process? It entails establishing processes, as well as implementing tools to assist with workflow and manage the flow of data.
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DELEGATED CREDENTIALINGKey processes to implement Delegated Credentialing Program include:
Adopting Credentialing Standards — The National Committee for Quality Assurance (NCQA) has already established standards for payers, as has the Joint Commission for providers. Standards from both organizations should be adopted, as well as any specific standards from regional payers.
Establish a Review Process — Create a committee to define processes and review provider credentialing.
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DELEGATED CREDENTIALINGConduct Ongoing Monitor — Develop processes to continually monitor work quality.
Re-Credentialing — Create processes to easily re-credential providers on an ongoing basis.
Create Agreements with Payers —Delegated credentialing agreements need to be established, clearly stating structure and metrics, including:
Outlining the responsibilities of the payer and delegated entity.
Detailing metrics of how the payer can define and assess performance.
Developing ongoing oversight processes.
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CREDENTIALING SOFTWAREAccomplishing these processes requires sophisticated credentialing software that includes:
Analytics and reporting.
Dashboard presentations and milestone tracking.
Demographic import features.
Document management.
Reminders and notifications.
Task management and assignment features.
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omClinicspectrum is a healthcare services company providing outsourcing and back office solutions for medical billing companies, medical offices, hospital billing departments, and hospital medical records departments.
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