How to avoid Credentialing delays?

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HOW TO AVOID CREDENTIALING DELAYS?
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PRESENT SCENARIO
Todays healthcare organizations are consistently
getting larger, in terms of the number of
physicians within their group or network.
With this growth come additional and
time-consuming administrative hassles, such as
Provider Credentialing.
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PROBLEMS FACED
Verifying the credentials of an individual
physician can take up to six months.
These delays in the process can lead to lost
revenue, unhappy patients, delayed payments,
internal referral roadblocks, increases in
out-of-network services, as well as coverage and
referral issues.
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JHBMA ARTICLE
The July/August issue of the Journal of
Healthcare Billing and Management Association
(JHBMA) featured a cover story titled Delegated
Credentialing for ACOs and Other Integrated
Delivery Models.
The article does a superb job of detailing how
provider organizations can potentially avoid
these credentialing delays and issues by taking
matters into their own hands and implementing a
delegated credentialing program.
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ARTICLE INSTANCE
Delegated Credentialing is where healthcare
organizations outsource components of their
credentialing to third parties, such as certified
credential verification organizations (CVOs).
However, delegated credentialing is a function
that is ideal to be taken on by provider
organizations, such as health systems,
Independent Practice Associations (IPAs),
Accountable Care Organizations (ACOs), and
patient-centered medical homes. Essentially,
these provider organizations can credential their
own providers by setting up formal delegated
credentialing agreements with their payers.
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BENEFITS
The benefits of taking on delegated credentialing
are substantial, including
Reductions in credentialing process
delays. Physicians are credentialed quicker,
boosting revenue and clinical bandwidth. Informat
ion is collected once, and reused for all
credentialing processes. Re-credentialing is
simplified.
It all seems so crystal clear. Outsourcing
credentialing is the way to go.
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DELEGATED CREDENTIALING
How to create a Delegated Credentialing Program?
Delegated Credentialing is an opportunity for
large provider organizations to take matters into
their own hands, streamline processes and realize
substantial benefits. These include getting
providers credentialed quicker so they can
generate revenue and expand clinical
bandwidth. So, how do organizations create a
delegated credentialing process? It entails
establishing processes, as well as implementing
tools to assist with workflow and manage the flow
of data.
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DELEGATED CREDENTIALING
Key processes to implement Delegated
Credentialing Program include
Adopting Credentialing Standards  The National
Committee for Quality Assurance (NCQA) has
already established standards for payers, as has
the Joint Commission for providers. Standards
from both organizations should be adopted, as
well as any specific standards from regional
payers.
Establish a Review Process  Create a committee
to define processes and review provider
credentialing.
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DELEGATED CREDENTIALING
Conduct Ongoing Monitor  Develop processes to
continually monitor work quality.
Re-Credentialing  Create processes to easily
re-credential providers on an ongoing basis.
Create Agreements with Payers Delegated
credentialing agreements need to be established,
clearly stating structure and metrics, including
Outlining the responsibilities of the payer and
delegated entity.
Detailing metrics of how the payer can define and
assess performance.
Developing ongoing oversight processes.
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CREDENTIALING SOFTWARE
Accomplishing these processes requires
sophisticated credentialing software that
includes
Analytics and reporting.
Dashboard presentations and milestone tracking.
Demographic import features.
Document management.
Reminders and notifications.
Task management and assignment features.
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CONTACT US
2222 Morris Ave. 2nd Floor,Union, NJ-07083
Website http//clinicspectrum.com/
Phone Number 908.834.1608
Email info_at_Clinicspectrum.com
Clinicspectrum is a healthcare services company
providing outsourcing and back office solutions
for medical billing companies, medical offices,
hospital billing departments, and hospital
medical records departments.
Copyright 2014. Clinicspectrum, All Rights
Reserved.