99MGMT Blog

Physician Credentialing Essentials: Boost Compliance and Efficiency

Posted by 99 MGMT on Dec 22, 2024 11:30:00 AM

physician-credentialing

Physician credentialing isn’t just a procedural necessity; it's a strategic linchpin in building a robust medical practice. 

Credentialing can be as daunting as it is critical, often mired in cumbersome processes that can sap both time and energy from your practice’s core focus — patient care. Yet, this process is crucial for your practice to ensure compliance, maintain seamless operations, and provide uninterrupted patient care.

In this article, we’ll navigate through the intricacies of credentialing efficiently. Streamlining this process means your practice can meet necessary compliance standards and enhance overall efficiency, leading to better patient outcomes and a healthier bottom line.

What Is Physician Credentialing and Why Does It Matter?

Physician credentialing is the process of verifying a physician's qualifications, licenses, and certifications to ensure they meet the standards required to practice medicine in Texas. This process is essential for maintaining compliance with federal and state regulations, ensuring patient safety, and optimizing operational efficiency within a healthcare practice.

Credentialing is crucial for several reasons:

  • Compliance: Adhering to regulatory requirements, such as those set forth by the Centers for Medicare & Medicaid Services (CMS) and state licensing boards, is essential to avoid penalties and sanctions.

  • Patient Safety: By verifying a physician's qualifications and experience, credentialing helps ensure that patients receive care from qualified and competent providers.

  • Operational Efficiency: A well-managed credentialing process can streamline administrative tasks, reduce delays in provider onboarding, and improve overall operational efficiency.

 

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Physician Credentialing Phase 1: Preparation

Preparation is the cornerstone of efficient physician credentialing. By laying a solid foundation, you can minimize delays and ensure that all necessary documentation is in place for a seamless process. 

Here’s what you need to focus on before engaging potential applicants:

 

Potential Applicants

When looking to fill a job position within your private practice, you may be able to speed up the credentialing process slightly by developing a “short list” of potential candidates who you think may be qualified or interested.

While you cannot start the official physician credentialing process before a physician applies, you can create a list of licensed practitioners in your area with the special skills necessary to work in your office.

Doing this saves time by ensuring that some applicants are already checking off some of the necessary boxes. This isn’t to say you shouldn’t consider applicants not on the list of physicians you scouted.  However, it won't change what you receive but what you review.

 

Contact Information

As we mentioned once or twice before, physician credentialing is a long, tedious process. You can make the process run more smoothly by ensuring you have up-to-date contact information for any applicants.

Several points throughout the credentialing procedures will require you to provide updates or obtain new information from a physician, so current contact details are crucial.

 

Provide Instructions

A surefire way to increase the likelihood of a smooth credentialing process is to provide adequate instructions to applicants. This ensures they provide all the information necessary for vetting. 

For example, you may want to make sure you inform physician applicants in advance that you will need the following articles (at minimum):

  • Information on work history and education
  • A current CV
  • Board certification
  • State licensure information
  • Malpractice liability certificate
  • Any controlled substance certificates 

 

Weak Applications

In addition to being slow, the process of physician credentialing is also expensive. Do yourself and your practice a favor by weeding out the weak applications early.

While the line is sometimes blurry on the surface as to which applicants are stronger or weaker, there will likely be some potential candidates who are unqualified for your position.

Whether from a malpractice claim or a lack of adequate experience, eliminating those who don’t fit the determined criteria will save money when you can avoid starting the credentialing process for an individual who won’t get the job anyway.
 

Physician Credentialing Phase 2: Reviewing Applications

The application review phase is where careful attention to detail becomes essential. Ensuring each application is complete, accurate, and meets all requirements helps avoid delays and complications. This step sets the stage for thorough evaluations, including background checks and verification processes, to confirm applicant qualifications.

Background Checks

Each aspect of the following must be completed for each applicant:

 

Peer References

When looking through references on job applications, it can be easy to overlook the importance of high-quality and appropriate peer references.

Ensuring applicants submit at least three references from individuals who have (or don’t have) certain qualities will save time and effort by setting you up for success when reviewing them. Ideally, all three references will be from physicians working in a similar field who are:

  • Not blood relatives
  • Not related by marriage
  • Not physicians from their current practice

 

Investigate Claims

Though no one wants to imagine that practicing physicians would engage in malpractice of any kind, it would be reductive to cling to that hope blindly.

Investigating any claims against an applicant will ultimately protect you and the future of your practice by decreasing the likelihood of the risk of malpractice down the road.

This is not to say that a physician with malpractice claims against them should never be credentialed. The claims are merely “red flags” that require further investigation to understand the context of the scenario.

 

Physician Credentialing Phase 3: Steps Along the Way

After the initial review, the credentialing process moves into a more detailed phase. This involves a series of steps to verify the accuracy of applicant-provided information and ensure they meet regulatory compliance.

Verification

To practice medicine at full capacity, physicians must obtain certain permissions from various hospitals for different aspects of their position.

For example, if a surgeon applies for permission to perform surgery at a hospital, they are given a list of approved procedures they may perform at that site. Additionally, physicians can apply for permission for specific procedures and receive confirmation that the practice they’re working for is even approved to perform said procedures.

Tracking Progress

We recommend that you create a checklist that will allow you to keep track of each step for each practitioner you’re working to obtain credentials for.

Additionally, to truly ensure that you’re staying on top of the many steps involved in this process, it is important to regularly return to that list and double-check that each step has been completed or is in progress.

 

Submit Applications

Once you have completed all the necessary steps of the physician credentialing process, you can send completed applications to the governing board for approval.

From this point, the governing board will review the applications and point out any concerns or issues to be revised or dealt with.

Since there are many points much earlier in the credentialing process where problematic information is spotted about any particular physician, any applications that make it to the governing board will likely be approved.

Applications with issues don’t automatically spell the end for an otherwise qualified physician. The board may approve them but mandate the physician be “proctored” or monitored for a time before they are considered fully credentialed. 

 

Physician Practice Management Services: An Alternative to In-house Credentialing

Efficient physician credentialing isn’t just about ticking boxes — it’s about building a strong, reliable foundation for your practice’s success.

Every well-credentialed provider ensures compliance and reinforces the trust and reputation your practice needs to thrive. With preparation, attention to detail, and a clear plan, you can turn credentialing challenges into growth and operational excellence opportunities.

However, physician credentialing is a very long process that takes time and effort.

On average, practice owners spend 43 minutes per day on credentialing. Based on salary alone, this can equate to upwards of $20,000 per year in lost productivity.

 

Credentialing Made Easy With 99MGMT

Consider partnering with a practice management consulting services company like 99MGMT for a streamlined credentialing process. Our team of experienced professionals possesses a deep understanding of the healthcare landscape and can handle every step of the credentialing process efficiently and accurately. This takes the burden off of your staff, allowing them to focus on providing excellent patient care. 

Contact 99MGMT today to discuss how our customized credentialing solutions can empower your practice for success.

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