Processes are always changing in the medical services arena, which is one of the many reasons we conduct a Medical Staff Credentialing survey every year. The goal of our survey is to identify top credentialing trends so that organizations like yours can better evaluate and manage credentialing operations.
We surveyed 1,008 Medical Staff Professionals for our 2021 report and landed on a few trends we believe will impact credentialing for years to come.
Close to 64% of survey respondents said they verify claims histories directly with the carrier for both current and previous coverage. Historically, this has always been the way to handle claim verifications, as it helps to avoid negligent lawsuits—but is there a more efficient way to handle this? A request for claim history with a malpractice carrier can take weeks, and in many cases even after the long wait, you may not discover anything new, so does this really make sense?
Neither The Joint Commission nor CMS requires claim histories to be verified, and the NCQA states that information can be seen within the NPDB query results with the provider self-reporting on the application. In fact, around 25% of our surveyors rely on NPDB results for that information, an excellent strategy in speeding up the process while obtaining the facts. Though the trend at the moment is leaning heavily in the direction of verifying claims histories directly, we believe following NCQA recommendations will go a long way in accelerating the process for all parties involved.
Years ago, it was common to request claims histories from as far back as when the applicant completed training until the present day. Nowadays, only 10% of respondents do this. Most choose to look back between 6-10 years instead. We find this practice a logical one; imagine a provider who completed a residency in 1980 in a high-risk specialty, who had a $5,000 nuisance settlement to close a case from 20 years ago, who hasn’t had any other incidents — is it worth the trouble to go so far back when nothing else has happened? We think adopting this change could help cut down process time, keeping you and your applicants happier throughout the process.
Of those surveyed, 84% continue to obtain current and prior affiliations, and 28% still verify everything since training completion. Interestingly enough, The Joint Commission has not required verification of affiliations for years. In fact, most of the time, those checks only yield the standard “in good standing letter”, which as we all know isn’t very informative.
43% of our respondents have limited affiliation verifications, going back 6 to 10 years. And 13% only obtain verifications from current facilities. We believe looking into limited affiliation verifications may yield a better return on your investment. We recommend doing some research within your system to find out how many providers who were credentialed over a certain period had red flags. If that made an impact on approval decisions, start pulling reports and learn how many providers were kept off your staff simply because they had a slightly negative entry from an insurance company, affiliation, or licensure agency. The combination of in-house research and limited affiliation verifications may be the perfect strategy to get accurate verifications in a timely manner.
Of the 1,008 surveyed, 53% accept electronic signatures in lieu of “wet” signatures for application packets. While some electronic application users seem to require a certain number of “wet” signatures, this could change! Most payers and organizations have the ability to accept electronic signatures, it just might not be something they advertise. We recommend reaching out and asking, as it may have been the case for years and they just never got around to announcing it. This is another opportunity to improve the process for the entire organization.
Onboarding is a hot topic these days, with almost 44% of medical staff offices responsible for their onboarding process. How can we shift some of those responsibilities to allow MSPs to focus on day-to-day credentialing operations? A new trend we see developing is the creation of a navigator or a concierge program that handles all onboarding-specific tasks. This role would serve as the primary contact for the provider and guide them throughout the entire process. Though only 12% of surveyors are going in that direction right now, it’s a trend we believe will continue to grow and provide value.
These trends are only a sampling of what our 5th Annual Medical Staff Credentialing survey uncovered. To get the full scoop, grab your copy of the report and check out our webinar covering the key findings. And, if you are thinking about making the switch to electronic privileging or credentialing, you’ve come to the right place and we’re here to help. Schedule a free demo with us, and let us show you the benefits of setting up a single source of truth for your entire provider lifecycle.