Examine Your Credentialing Program

Examine Your Credentialing Program

May 14, 2019
  • Author:
    Vicki Searcy
    Former VP, Consulting
    Vicki has managed several credentialing and privileging practices, led a national healthcare accreditation and compliance consulting practice, was a surveyor for the NCQA, and a former president of NAMSS.

In early May, Renee Aird Dengler, RN, MS, CPMSM, CPCS, FMSP (Senior Consultant/Independent Contractor with VerityStream) and Renee Zimmerman, RN, MSN, MBA, CPMSM, CPCS (Assistant Vice President, Franciscan Physician Group, Franciscan Missionaries of Our Lady Health System) presented a webinar on the topic of putting your credentialing program on a diet.  The point of the webinar was elimination of non-value added activities from the credentialing process – as well as activities that have been done for years but are not required by an accreditation program. There are obviously a lot of you out there who are interested in this subject because hundreds of organizations participated in this webinar!

This topic can be very emotional for many credentialing professionals, because we know how important the credentialing process is to our organizations and the patients that we serve. The suggestion that steps can be eliminated from the credentialing program is abhorrent to many because of the perception that eliminating steps damages the integrity of the credentialing process.

When is a “best practice” really a best practice? Who decides?

As a consultant who has had the opportunity to work with hundreds of hospitals across the nation, I can attest that while there are many things that credentialing programs have in common, there are numerous areas where organizations disagree on what constitutes a “best practice” when it comes to what is asked of applicants, what is verified and how the decision-making process is carried out. Health care attorneys don’t always agree on these elements either! It can make it confusing for organizations that want to set up the best possible credentialing program.

For example, some organizations believe that it is critical that an applicant complete a pre-application form prior to getting access to an application. Other organizations don’t use a pre-application at all. Some organizations verify all the hospital affiliations that an applicant has ever had. Other organizations may elect to verify only those that occurred during the past 24 months. And so on…. And in the examples that I just used, these are items where organizations have discretion to set their own standards as they are not stipulated by regulatory/accreditation requirements.

What is an organization to do?

It is particularly hard these days when most credentialing departments are being urged to get credentialing done as quickly as possible so that providers are able to see patients (and bill for those patients). On the one hand, we do want to complete credentialing as soon as possible – but we don’t want to take shortcuts that could compromise the reputation of our organization – and worse yet – potentially harm patients.

My best advice is for you to do a detailed map of your credentialing process, including all the steps, verifications, etc. Then identify which items are required (and by whom) vs. what items are discretionary. Then focus on the discretionary items and give some thought to how the discretionary items provide value to the credentialing process. For example, many organizations have determined that a background check at the time of initial credentialing brings value – but in most cases, it is not required (a few states do require some type of background check). The main point is to examine all the discretionary items/processes and make sure that they are value-added, which means that they lead to making better credentialing decisions. The worst thing that organizations do is to keep on doing something because it has always been done that way without giving thought to why something has always been done.

Bottom line – I’m happy to identify what I think are credentialing best practices – but ultimately, for those discretionary items, it will be up to you and your organization to decide.