Overcoming Medical Group Turnover with a Solid Credentialing and Enrollment Process and Supporting Software

Overcoming Medical Group Turnover with a Solid Credentialing and Enrollment Process and Supporting Software

Oct 11, 2022
  • Author:
    Noelle Abarelli

A certain amount of turnover is expected in any industry, but within the healthcare industry, it can be especially tough to manage. If you lose a Medical Service Professional (MSP), your credentialing process could be at risk. At VerityStream, we are dedicated to ensuring competent providers are delivering next-level patient care. One way to achieve this goal is to develop solid credentialing requirements and policies that enable new MSPs to be trained on your processes quickly. Credentialing policies also offer an excellent resource for bringing on new providers as a solid structure offers a sustainable method of standardizing what you do and how you do it from the eyes of your providers.

Credentialing Standards to Consider

Every organization will have differing needs, but checking the NCQA standards for guidance is a worthy place to start when developing your own credentialing standards. Some details we suggest including in your policies are:

  • Who is credentialed
    • Your policy must include who you credential most commonly, be they physicians, professional nurse practitioners, physician assistants, physical therapists, occupational therapists, audiologists, pharmacists, etc. This should also include details on what specifically needs to be verified as well as by which sources.
  • Approval process
    • The policy should delineate what is required for the approval process to ensure all the proper data is gathered accordingly. Oftentimes, applications come in with missing information, so having guidance on what to look for will make it easier to reach out to new providers so that they may provide clarity when needed.
  • Timeframes
    • Whether it’s credentialing or reappointment, it takes time, and time is a precious commodity. Therefore, having designated time frames to abide by is critical in keeping the process moving without delay. Timeframes should be specified in policies so there are periodic checks and balances to ensure nothing falls by the wayside.
  • Ensuring confidentiality
    • Medical data is sensitive and must be kept secure at all times, it’s one of the many ways organizations are able to keep everybody safe. That is why your credentialing policies must dictate what steps must be taken to ensure all information is kept secure at all times.
  • Nondiscriminatory processes
    • Credentialing policies must also include information on the organization’s commitment to nondiscriminatory practices, outlining them specifically. Creating and monitoring nondiscriminatory practices should be a key component of your policies and procedures.

There is a lot to consider. But having clearly stated credentialing requirements and policies will ensure credentialing is a smooth process for your organization.

Provider Data Management

Having a process in place is just one important piece of the credentialing puzzle. Credentialing relies on data - lots of it - so you also need a process for managing provider data. As you establish a method for this, there are a few areas that we believe are critical to your organization’s success:

  • Data governance policy
    • The data governance policy will dictate who the business administrator is, who the IT specialist is, who inputs new information into the database, etc. Having these designations set in place is critical to ensuring data is up to date, but most importantly, clean.
  • Data Governance Committee
    • Some entities may benefit from a data governance committee, especially when a fast turnaround is needed.
  • Provider data standards
    • Outlining what information is required for providers is critical, it’s especially important for pre-populating payer forms and rosters, which saves time and money.
  • User groups and permissions
    • Establishing permissions for different sets of people and groups helps with being organized, but also with confidentiality. Only individuals given set permissions are able to access certain information, whether as an individual or a group. This can include setting permissions for who can and cannot make changes to data within the system, which helps with accountability.
  • Request change/addition to provider data
    • The way in which provider information is updated must also be standardized so that only the most up-to-date and accurate information is included.
  • Manage provider data changes
    • Monitoring any changes to provider information is critical as they have a direct impact on payments.
  • Workflows
    • Workflows are another way to manage providers whether you’re trying to get them through initial credentialing, initial enrollment, re-credentialing, or reappointment. Workflows can be used to address provider changes as they come in a standardized fashion.
  • Reporting
    • The ability to pull data integrity quality reports will help you maintain an accurate database. Some data elements you might want to consider creating standard content reports around include:
      • Tax ID
      • Social security number
      • Office designation
      • Primary mailing and billing address

Overcoming Turnover in a Medical Group: How Credentialing Software Can Help

Having a credentialing software like CredentialMyDoc in place gives structure to your processes and makes it easy for a new person to step in to manage credentialing and enrollment. It includes all the fundamentals you need in one easy-to-use, web-based, relational database. CredentialMyDoc enables:

  • Onboarding
  • Primary Source Verification (PSV)
  • Form generation
  • Workflows
  • Payer and facility tracking
  • Management of expirables
  • Reporting

CredentialMyDoc also speeds up the process of credentialing and enrolling new providers. Instead of emailing an onboarding checklist, you can offer an online application that feeds information right into CredentialMyDoc. This cuts down on a lot of back and forth and improves data accuracy tenfold in many cases! The process is also a lot more secure as you aren’t emailing confidential documents back and forth. With CredentialMyDoc you can:

  • Store, protect, and share provider information
  • Rapidly complete applications
  • Interface and exchange documents with providers through a secure provider portal
  • Utilize dozens of pre-built reports and workflows and build custom reports
  • And, more!

Finding someone who knows credentialing and enrollment inside and out can be challenging. But with CredentialMyDoc, you get a secure cloud-based solution that can be accessed anywhere at any time. This opens up the ability for medical groups to tap into the top talent they need to keep up with demand even if they’re dealing with high turnover rates. If you’re worried turnover might slow you down, learn more bout CredentialMyDoc. Check out some of our success stories and reach out for a demo.