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 and with the required sources, credentialing serves as the public’s number one mechanism in assuring competent, quality care. Due to the importance of a comprehensive credentialing program on public health, it should not be dismissed, delayed or disregarded as merely an ‘administrative paper-pushing headache’.
Many organizations who have taken on credentialing responsibilities find it challenging to master the process on a macro level. Ever-changing laws and standards impacting credentialing can be difficult to stay abreast of and/or implement. Some organizations minimize the importance of a compliant, comprehensive credentialing program, and relegate execution of the program to inexperienced administrative professionals who are unable to apply the standards and do so within the varying prescribed timeframes. The result is lower quality, loss of revenue, departicipation with commercial, state, and federal payers, and potentially even state and federal fines.
When does outsourcing your credentialing make sense? It makes sense when the challenges to start up or maintain a credentialing program could be or become problematic in all of the above areas. Sometimes, by the time a failing credentialing program is recognized, it’s almost too late. When considering to outsource, or ‘delegate’ credentialing functions, it’s best to assess the knowledge base and abilities of your administrative team before embarking on a credentialing program. Or, in those cases when a credentialing program has become broken, inefficient, backlogged and non-compliant, or if your organization lacks qualified credentialing professionals to perform the work, it’s time to consider calling on experts to perform the function on your organization’s behalf.
When considering outsourcing/delegation of credentialing activities, do your research. Not all organizations that offer credentialing services are created the same. Those that are dually-assessed by the National Committee on Quality Assurance (NCQA) and the Utilization Review Accreditation Committee (URAC), like PCVS, have undergone rigorous review and periodic re-review against all regulations and standards and have received the gold standard in the industry for credentialing services. Also consider how long the credentialing services organization has been in business, and perhaps even ask for references from their existing clients.
PCVS recognizes each organization as a unique and can tailor services to your organization’s needs. Contact us today to learn how we can assist your organization with high quality, gold standard credentialing services.