The Benefits Of Outsourcing For Hospital Credentialing

The Benefits Of Outsourcing For Hospital Credentialing



Hospital credentialing is​ the most intensive credentialing process for​ medical providers, repeated more frequently than other credentialing standards and​ involving more organization​ contacts and​ supporting documents. The amount of​ staff time and​ the expense of​ researching every medical provider can be heavy, draining resources from other administrative functions, and​ requiring experienced staff and​ access to​ research resources. Yet hospitals have been slower than other medical organizations to​ outsource the credentialing process, despite potential benefits: faster turnaround time, cost-effectiveness, and​ savings in​ staff time and​ training.

Hospital credentialing covers the most detailed questions of​ any credentialing standard, from medical school through the provider’s complete career. The Joint Commission​ on​ Accreditation​ of​ Healthcare Organizations (JCAHO) creates manuals outlining the credentialing processes for​ all different medical providers within​ an​ institution. The proscribed areas have to​ be verified in​ ways that meet JCAHO standards. this​ entails direct contact with organizations associated with the provider, as​ well as​ receiving copies of​ all certificates and​ licenses. All of​ these areas must be verified:
  • DEA certificates
  • All state licenses and​ sanctions
  • Malpractice insurance and​ claim history
  • Training, internships, and​ residencies
  • Board certifications
  • Medical education
  • All past and​ current hospital privileges
  • Work history (verified through direct contact)
  • Medicare sanctions or​ opt-outs
  • Peer references

Both the contact results and​ supporting documentation​ are gathered to​ create a​ final profile report for​ the provider, which is​ given to​ the credentialing committee for​ review. Any warning signs or​ previous problems with the provider must specifically be brought to​ committee attention.

Most hospitals still do credentialing verification​ internally. if​ they have full access to​ information​ resources and​ available money and​ manhours to​ dedicate staff, as​ well as​ having experienced personnel to​ do it, then in-house credentialing can be as​ fast and​ thorough as​ outsourcing it. Most hospitals do not have those resources or​ need to​ assign those resources elsewhere. Moreover, hospitals bear the liability of​ any mistakes or​ oversights made during the credentialing process, and​ those mistakes can affect the results of​ future audits, resulting in​ reprimands or​ penalties.

Credentialing verification​ organizations (CVO) allow hospitals to​ outsource the credentialing process for​ all medical providers, such as​ physicians, respiratory therapists, X-ray technicians, nurses, and​ mental health specialists. CVOs dedicate resources and​ training to​ credentialing, meaning personnel have experience, comply with appropriate standards, and​ have access to​ verification​ resources. Hospitals can better utilize their staff and​ finances, while lowering hospital liability for​ mistakes. Additionally, CVOs can offer support services in​ addition​ to​ credentialing which can make managing audits, renewing licenses, and​ other processes more efficient.

There are minimum services that CVOs should offer to​ hospitals:

  • Compliance with JCAHO standards.
  • Minimum number of​ contact attempts to​ and​ organization.
  • Adapting processes to​ incorporate hospital requests and​ specialized information​ requirements.
  • Completed profiles with no sections left unverified.
  • Improved turnaround time, usually within​ 60 days.
  • Quick committee notification​ for​ problematic files.
  • Fast response to​ questions or​ problems.
  • Web access to​ profile reports and​ verification​ documentation, as​ well as​ hard copies.

Quality CVOs offer other beneficial, resource-intensive services to​ hospitals:

  • Surveillance between an​ initial credentialing process and​ the first recredentialing process for​ any disciplinary actions or​ sanctions.
  • Routine notification​ for​ recredentialing and​ expirable deadlines.
  • Assistance during internal or​ external audits.
  • Training and​ consulting for​ in-house credentialing.

Using a​ CVO for​ medical provider credentialing saves hospitals time in​ staff hours, money and​ resources, and​ also offers support services, such as​ audit support and​ surveillance of​ providers for​ sanctions or​ problems even after completing credentialing, that a​ hospital may not be able to​ maintain​ internally. Hospital credentialing standards are the tightest and​ most detailed of​ medical provider credentialing standards. CVOs can remove the burden of​ meeting those standards for​ hospitals through dedicated resources, experience, and​ support services.




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