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How to Handle Physician Credentialing Efficiently in your Practice

Posted by 99 MGMT on

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Physician credentialing - every physician goes through it. It’s a long and tedious process, but it is absolutely imperative to complete if you plan to actively practice medicine.

Despite this being a painstakingly detailed and lengthy task, there are a few ways you can boost efficiency when it comes to credentialing, whether you do it yourself or you contract a third-party to assist.

Here are our tips to help you handle physician credentialing more efficiently in your private practice.


Phase 1: Preparation

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 prior to a physician’s application being submitted, you can create a list of practitioners who are licensed in your area and who have the special skills necessary to work in your office.

Doing this saves time down the road by ensuring that some who may apply for your opening are already checking off some of the necessary boxes. Doing this doesn’t mean you shouldn’t consider applicants who were not on the list of physicians you scouted, but will significantly increase efficiency if you do receive applications from those who are on the list.

Contact Information

As we mentioned once or twice before, physician credentialing is a long, tedious process. One way you can ensure that the process goes smoother is by making sure you have up-to-date contact information for any applicants.

There will be several points throughout the credentialing procedure where you will need 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 the credentialing process going smoothly is to provide adequate instructions to applicants so they can ensure they’re providing all the information necessary.

For example, you may want to make sure you tell applying physicians 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 on.

While the line is sometimes blurry on the surface as to which applicants are stronger or weaker, there will likely always be at least a couple potential candidates who come through that are simply not qualified 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 anyways.


Phase 2: Reviewing Applications

Background Checks

Now that we’re starting to get into the actual credentialing process, it’s time to begin background checks on each physician to be credentialed.

It is imperative that each aspect of the following is completed for each applicant:

  • Verifying training and education through the American Medical Association or the Educational Commission for Foreign Medical Graduates if the applicant was educated outside the United States
  • Verifying current medical licensure in the state your practice is in
  • Verifying employment history
  • Verifying Medicare sanction information through the OIG Sanctions Exclusion Database
  • Querying the National Practitioner Data Bank on closed and settled claims history
  • Reviewing any time gaps in education or career, and obtaining any additional information, if necessary
  • Verifying the status of the applicant's privileges at hospitals and other health care facilities as listed on the application

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 that applicants submit at least three references from individuals who have (or don’t have) certain qualities like the following will save time and effort by setting you up for success when reviewing them:

  • Not blood relatives
  • Not related by marriage
  • Not physicians from their current practice
  • Physicians who work in a similar field 

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.

Taking the time to investigate any claims against an applicant will ultimately protect you and the future of your practice by decreasing the likelihood of 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.


Phase 3: Steps Along the Way


In order 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 particular site. Additionally, physicians can apply for permission for specific procedures and receive confirmation as to whether or not the practice they’re working for is even approved to perform said procedures.

Tracking Progress

When trying to fill any job position, there are many steps throughout the process that must be completed. That list only grows longer when you tack on physician credentialing procedures.

We recommend that you create a checklist that will allow you to keep track of each step along the way for each individual 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 the process of being completed.

Submit Applications

Once you have taken care to complete all the necessary steps of the physician credentialing process, you can prepare to 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 with them to be revised or dealt with.

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

However, if there are any issues with an application for a physician who is otherwise qualified, they may be approved, with the caveat that they will be “proctored” or monitored for a set period of time before they are fully considered credentialed.


Alternative Option: Practice Management Services

As we pointed out more than once, physician credentialing is a very long process with a lot of steps. This means that processing these applications takes a lot of 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.

If you think that spending so much time credentialing is taking away from your ability to care for more patients, consider employing Practice Management Services, like 99MGMT!

For more information on these services offered, check out another one of our blog posts, “Are You Wasting Money Handling Physician Credentialing Yourself?”

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