Five Physician Credentialing Tips to Improve Your Process

That's a lot of time spent not seeing patients.

So, we're here to give you tips on how to create a credentialing process that gets qualified physicians in front of patients faster. Whether at a bustling hospital or growing practice, these strategies take the headache out of credentialing. Let's get started.

1. Set Clear Policies and Document Everything

If the credentialing team doesn't know your policies, you're setting them up to fail. That's why the first step of improving a credentialing process is to document policies and procedures, ensuring everyone knows what's expected.

At a minimum, this draft must include:

• Physician Eligibility
  Define the minimum qualifications, certifications, and experience each physician must meet before enrolling.
• Necessary Documentation
  Make it clear which documents a physician will need to provide, including licenses, diplomas, insurance records, board certifications, peer references.
• Defined Process
  Get clear on your process. At a bare minimum, include application intake, primary source verification, and committee approvals. Define who owns each step and the expected timeline. Spell it out clearly.
• Discrepancies & Re-credentialing Policies
  What happens if something doesn't match up during verification? And how often will you re-credential physicians? Have those policies locked down.
• Staying Informed
  Stay aligned with industry standards from key organizations like The Joint Commission (TJC) and the National Committee for Quality Assurance (NCQA). Regulations vary by state, too, so don't overlook the local rules!

Don't just put these guidelines into a PDF on a local computer. Store them centrally so your team can easily access and update them.

2. Build on Technology, not Paper

Stop basing your credentialing process on spreadsheets or paper trails. It's not the 20s; it's the 2020s and time to upgrade. Credentialing software automates repetitive tasks and eliminates manual errors. Credentialing platforms can:

• Standardize processes so you're not starting from scratch every time a physician applies.
• Speed up primary source verifications by integrating with online databases like NPPES, ABMS Board, SAM.gov, AMA, and more.
• Flag expiration dates for licenses and certifications.

Invest in tech that allows your team to focus on verification accuracy and onboarding efficiency rather than chasing down paper trails.

When selecting credentialing software, look for integrations with your EHR and HR systems. When more departments have access to the same data, you save time and ensure accuracy.

3. Monitor and Adapt Continuously

Healthcare regulations change. Industry standards evolve. That's why credentialing isn't a "set-it-and-forget-it" task. To keep your credentialing process in-line with constantly changing standards:

• Perform internal audits regularly to uncover bottlenecks.
• Stay informed of industry changes, particularly concerning state laws and licensing requirements.
• Get feedback from your team about what's working, what isn't, and where they see room for improvement.

Monitoring means you're committing to continuous improvement. It future-proofs you against constantly changing healthcare regulations.

Follow organizations like NAMSS (National Association of Medical Staff Services) and subscribe to healthcare regulatory newsletters. They're crucial for staying up-to-date.

4. Rely on Other Departments

Think credentialing is only a one-department gig? Think again. Your HR team, compliance department, and medical staff services team should be part of the process. Why? Because credentialing is a collective effort between HR, compliance, and medical staff services.

• HR can assist with employee onboarding logistics
• Compliance ensures your organization is meeting regulations and avoiding disruptions in care delivery.
• Medical staff services provide insights into role-specific qualifications and physician expectations.

Collaboration isn't just about being more productive. It's also about building a process where every department brings what it does best to assemble a complete picture of every physician who applies. Set regular cross-departmental meetings or use a shared task-tracking system to keep everyone on the same page.

5. Continuously Improve Your Process

Credentialing processes shouldn't be "set-it-and-forget-it". The best teams regularly reevaluate how they're doing things. Whether it's internal feedback, advice from peers, or insights from webinars, there are always ways to refine your process.

Start with these:

• Get feedback from your stakeholders, like physicians and department heads, to understand where bottlenecks are.
• Benchmark your process against industry standards.
• Stay open to innovation. That might mean evaluating new tech, piloting verification methods, or A/B testing new applications.
• Attend industry conferences to learn new ideas and best practices. Even an hour-long webinar could inspire an improvement that saves your team hours in the future.

A Better Credentialing Process

Ensure your patients have access to the best care possible by documenting your process, using technology instead of paper, keeping an eye on new trends, and collaborating across the hospital.