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The Physician Credentialing KPIs You Need to Track

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Written by Matt Fiel on January 24, 2025

Provider credentialing doesn't depend on one department. It's a collaborative effort that involves medical staff services, human resources, compliance, quality assurance, finance, IT, and executive leadership. Each of these departments has different goals, both business and emotional. When everyone isn't on the same page, conflicting priorities can create weak points and gaps in the process, negatively impacting the big picture.

Credentialing KPIs

Making sure the big picture is healthy means taking a quantitative approach, which starts with measuring the right KPIs for each team.

Let's break those down.

Medical Staff Services

At Penrod, we're not above making healthcare puns...and if the credentialing function had a heart, the medical staff services team would have a pulse. Made up of individual contributors like coordinators, credentialing specialists, and staff directors, they set the rhythm for managing the entire credentialing process. The KPIs of staffing services focus on timeliness and accuracy.

Key KPIs

  • Average Credentialing Time
    Measures the time it takes from application submission to final approval
  • Application Accuracy Rate
    Reports errors or missing information from submitted applications
  • On-Time Application Rate
    Measures how often staff meets credentialing deadlines
  • Re-Credentialing Compliance Rate
    Ensures physicians don't routinely lose compliance
  • Average Priveledging Time
    Shows how quickly staff grant physician privileges after credentialing

Human Resources

Human Resources are most present during the recruiting and onboarding stages. They're responsible for finding talent and consist of onboarding specialists, acquisition specialists, and talent directors. Human resources KPIs come down to the speed and quality of the onboarding process.

Key KPIs

  • Provider Onboarding Time
    Tracks the time it takes to onboard a new physician after credentialing is finished
  • New Hire Verification Rate
    Measures how many newly hired physicians staff successfully credentialed
  • Background Check Accuracy
    Measures the quality of newly hired physicians
  • Retention Rate
    Measures the cultural fit of recruits and effectiveness of the onboarding process, usually over one year
  • Response Time
    Measures the time it takes for HR to respond to credentialing questions

Compliance

Compliance KPIs are all about, well...compliance. In other words, how well is the credentialing process ensuring that physicians comply with regulatory standards? These strategies are typically created by a compliance officer and informed by risk managers or legal counsel.

Key KPIs

  • Accreditation Compliance
    Tracks compliance with standards like The Joint Commission or Centers for Medicare and Medicaid Services (CMS)
  • Ratio of Providers with Active Licenses
    Monitors percentage of physicians with current certifications and licenses
  • Audits Passed or Failed
    Reveals audit success and failure rates over time
  • Incident Rate
    Identifies adverse events related to gaps in the credentialing process
  • Provider Sanction Rate
    Shows the frequency of completed or updated sanction checks

Quality Assurance

Quality assurance KPIs measure patient safety and quality standards. It's easy for these measurements to feel qualitative, so it is essential to focus on quantitative metrics like accuracy and consistency. People involved in this process might include quality directors, performance improvement coordinators, or quality analysts.

Key KPIs

  • Error Rate
    Measures the amount of documents with procedural errors
  • Quality Flags Rate
    Reveals how often credentialing issues happen in reviews
  • On-Time Verifications
    Monitors how often staff complete physician credentialing on time
  • Performance Benchmarks
    Measures a hospital's credentialing process against industry standards
  • Patient Safety Indicators
    Monitors patient safety issues and complaints against a physician's qualifications

Finance

Finance is all about revenue cycle management. It typically involves many stakeholders, including CFOs, provider enrollment specialists, revenue cycle managers, and billing specialists. Their KPIs must focus on how the credentialing process impacts payer enrollments and reimbursements. Denials and revenue delays are a great way to measure this quantitatively.

Key KPIs

  • Enrollment Turnaround Time
    Measures the speed at which specialists enroll physicians with payers
  • Denial Rate
    Tracks denials that correlate with credentialing errors or delays
  • Revenue Impact
    Quantifies the financial impact of credentialing delays
  • Providers Credentialed for Payers
    Identifies gaps in physicians enrolled across relevant payers
  • Cost per Credentialing Case
    Measures the cost and efficiency of credentialing processes.

Information Technology

Depending on technical maturity, information technology is the backbone of the credentialing process. However, if your credentialing process is built on paper and manual tasks, IT may not have a huge role to play beyond email uptime. However, if your process is robust, IT's role comes down to adoption and reliability. The key players in any IT team start with the Chief Information Officer and, depending on the team's hierarchy, include IT specialists and credentialing software admins.

Key KPIs

  • System Uptime
    Measures downtime of the applications credentialing teams rely on, including SaaS tools for verification, credentialing, and communication
  • Automation Rate
    Benchmarks the amount of automated processes vs historically manual tasks
  • Software Error Resolution Time
    Tracks the speed at which the IT team responds to software issues
  • User Adoption Rate
    Measures the rate at which staff use credentialing tools
  • System Integration Ratio
    Evaluates how integrated credentialing processes are in the healthcare technical stack, including ERPs, EHRs, and hiring platforms

Executive Leadership

Executives are all about the big picture, so many of the most important from each department filter up. Think chief medical officers, chief executive officers, department chairs, and clinical directors. It's all about performance, cost, and alignment with overall objectives.

Key KPIs

  • Overall Compliance Rate
    Measures the rate of hospital compliance with regulations, best practices, and policies
  • Provider Turnover
    Tracks the impact of credentialing policies on provider turnover
  • Patient Outcomes
    Correlates clinical outcomes with physician qualifications
  • Credentialing Cost
    Tracks the financial implications of credentialing issues, delays, and errors
  • Completion Rate of Credentialing Initiatives
    Tracks completion of key strategies related to improving the credentialing process

Conclusion

Provider credentialing is a team sport; success comes down to tracking the right KPIs. Whether it's medical staff services, HR, compliance, or IT, every department plays a significant role in aligning with organizational goals. Every department can work towards a better credentialing process rooted in data-driven insights by measuring and improving on the key metrics we covered.

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About The Author

With over 15 years of experience in marketing strategy, web development, and creative design, I lead the marketing team at Penrod, a boutique Salesforce partner focused on the healthcare and life sciences industry. As a Salesforce Certified Consultant, I have deep knowledge and skills in leveraging the platform to optimize marketing automation, lead generation, and customer engagement.


Matt Fiel
EVP of Marketing

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