Author: Kevin McFatridge

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Delegated credentialing

Hospitals, health systems, managed care organizations, clinically integrated networks (CINs), accountable care organizations (ACOs), ambulatory surgery centers, large medical groups, and a variety of other organizations charged with performing provider credentialing activities are often limited on staff, time, credentialing expertise or experiencing inordinate credentialing volume that may prompt them to consider delegating part or all […]

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The Benefits of Outsourcing Credentialing

Many organizations tasked with practitioner credentialing struggle with shrinking budgets, staffing limitations, and credentialing volume that far exceeds their ability to process in a timely and compliant manner. These challenges often result in improperly performed credentialing and significant delays in practitioners being approved by various peer review bodies for enrollment, membership, privileges, and general ‘participation’ […]

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Guiding Principles of Credentialing  

While the function of credentialing clinical practitioners is characterized by some in the health care industry as a burdensome, bureaucratic administrative process, it is a mechanism to protect society from clinical imposters, assure a relative level of patient safety, and mitigate organizational risk. To this end, the principles that guide credentialing activities have long been […]

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Why Credentialing Matters

Credentialing is defined as the act of verifying a clinical practitioner is who they say they are, obtained the education and training they say they received, and through obtaining confirmation of the presence or absence of current or historical adverse actions against licensure, clinical privileges, board certification, and professional society affiliations or other professional practice […]

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What You Need to Know Before Talking to a CVO  

Managing credentialing functions can be challenging when there are a high volume of applicants and reapplicants, your internal staffing is in fluctuation, or your organization simply does not have the internal expertise to ensure a quality-driven and compliant credentialing program. Credentials Verification Organizations (CVOs) can assist in meeting the need to get things back on […]

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When Does Outsourcing Your Credentialing Makes Sense?

Credentialing, defined as primary source verification of an applicant is who they say they are, have the education they state they do, and are free from various state, federal, or other sanctions, is highly regulated in the health care industry by federal law, accreditation standards, risk management practices and organizational policies. When performed efficiently, consistently […]

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How Do I Start the Credentialing Process?

In addition to all of the considerations clinicians face in the practice of medicine, starting the credentialing process can seem like an overwhelming administrative endeavor, fraught with delays and frustration.  Keeping some key fundamental points in mind will assist in prioritizing and finalizing credentialing efforts. Hospital/Health System Based on your specialty, determine whether or not […]

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When Should I Start the Credentialing Process?

There are many important considerations when starting a new practice or entering into a new payer agreement that need to be taken into consideration.  Knowing when to start the hospital or insurance payer credentialing process is essential to proactively assuring timely reimbursements are flowing into a medical practice. Yet, it is often one of the […]

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Which Payers Should I Participate With?

Consideration of which insurance payers to participate with requires informed decision-making as a first step. Reserving time and effort to contract and enroll with only those payers who provide competitive and equitable reimbursements, represent a substantial size of the patient population served, and offer financial incentives for the containment of cost and the delivery of […]

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Credentialing for New Health Care Practices

Starting a new medical practice, or recruiting new physicians (or other clinical practitioners) to an existing practice is riddled with several administrative challenges. The primary one being proactive, timely application for medical staff hospital privileges and insurance enrollment and credentialing. These two factors alone directly correlate to a new practitioner’s ability to care and bill […]

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