Credentialing has long been known as one of the most complex processes in the healthcare industry due to the myriad of compliance issues it can lead to. To avoid this, healthcare providers must be aware of all the potential issues and risks that come with the manual credentialing process. Because manual credentialing is a long process that involves multiple people, files, and organizations, sometimes problems are not known until one takes an in-depth look at the current process. That’s why, today, we’ll be taking a look at 4 of the most common compliance issues you should be aware of.

1. Misplacing Files

Many healthcare agencies have unorganized systems with important files and documents spread through multiple departments. Due to the manual nature of traditional credentialing, individuals have to make up for the workload the process demands and are more prone to human errors. This not only results in increased paperwork and clutter around the office but also makes it very easy to lose or misplace these files. Lost or misplaced files prolong the credentialing process even further – just one lost document is all it takes to find yourself non-compliant with provider applications and regulations. On top of these challenges, it takes a lot of time and labor to regularly update, revise, and process each candidate file and checklist as new information and requirements arrive. You will be taking away time and resources that are needed elsewhere, which can negatively affect the efficiency and delivery times of your staff in other areas.

One of the best ways to deal with these challenges is to rely on an outsourced credentialing partner. An outsourced credentialing partner can considerably reduce the paperwork and need for additional labor thanks to digital solutions and platforms. This combination of proper platforms and dedicated specialists will lower costs, boost compliance, and enhance efficiency and productivity within your organization. 

2. Taking Too Long to Credential

Manual credentialing is a lengthy process. In fact, it can take as long as four months to credential a single candidate, which can be further extended due to delays and complications in qualification checks for candidates and providers. Additionally, credentialing requirements can change in as low as 90 days (approximately 3 months). This means that if you take too long to credential or qualify your candidate, you may have to start the whole process again due to the amendments in provider requirements. Keep in mind that working with multiple candidates and providers can complicate the process even more because of the increased paperwork and qualification checks.

Outsourcing to a credentialing partner – or at least investing in an automated credentialing platform – will allow for a reduction of complaints, complications, and costs on your end. Not only that but it can also get your candidates credentialed faster and more efficiently. The right credentialing solution can run background checks, compare and contrast information, and verify any additional information on their own at a much faster turnaround time.

3. Not Keeping Information Up-to-Date

When it comes to credentialing, it is vital to ensure that all information related to candidates, applications, and providers is complete and fully up-to-date. At the end of the day, maintaining compliance is the most crucial factor to consider when credentialing candidates. Every single detail must be verified and accurate. However, maintaining compliance can pose a serious challenge with manual credentialing because it only takes one simple mistake to lose track of requirements, dates, and deadlines. Organizations that are not able to maintain compliance are at risk for malpractice claims that can result in large fines and loss of licenses and credentials. 

To stay compliant with all the necessary information and requirements, it is important to have a credentialing partner who will keep you up-to-date and ease the whole process. Look for a company that can fully manage credentialing from start to finish. The right partner will be able to manage each application and provider requirement and verify all your providers in half the time, saving you time, money, and stress. 

4. Not Conducting Proper Training

As we’ve alluded to throughout this blog, credentialing compliance is extremely integral to the healthcare sector. The reason for this is to ensure that every aspect of an applicant’s profile is compliant with the requirements of the most relevant institutions in the field. Proper training is important to successfully credential while maintaining compliance. It allows everyone on the team to understand each individual regulation, verification steps, and checks. Not only that but it also allows each person to fully understand their role in the process, alleviating the challenges and risks associated with errors and miscommunication while fulfilling requirements, checklists, or qualifications. 

Training can take a lot of time and resources, especially if credentialing is handled manually. On the other hand, the right outsourced credentialing partner will educate and train each team member for increased efficiency and productivity on your behalf. When each person fully understands the whole credentialing process and their main responsibilities, achieving credentialing will flow more smoothly. Additionally, with everyone knowing their roles and duties, management will be able to focus on other more important areas of the business. 

Key Takeaways

There are so many compliance issues that can negatively affect the credentialing process. To be proactive and ensure compliance, healthcare organizations must take steps to optimize their onboarding efforts and processes. Take time to reevaluate your current credentialing practices; ask yourself: “Are there any gaps in our current process? And if so, what areas can we improve?” Answering these questions will be able to push you in the right direction to achieve a successful outcome. 

Organizations that are able to partner with a reliable credentialing partner will be able to enhance their workflow operations. Tollanis Solutions has the ability to alleviate the burden of manual credentialing by managing your credentialing process from start to finish. Contact us today to learn how we minimize compliance risks.

Ready to transform your credentialing process with Tollanis Solutions?