The Importance of Continuous Credentialing in Healthcare
Ensuring compliance at every step in practice operations has always been the primary job
of providers and healthcare organizations alike. Efficient credentialing serves as the
linchpin to maintaining high standards of patient care because the process efficiently
ensures that the providers meet the specific criteria, including the necessary
qualifications and expertise to deliver the best care. Traditionally, the credentialing
process is assumed to be served periodically at certain set intervals with providers
undergoing the verification process. However, alternating policies of maintaining
healthcare compliance, such as the demand for up-to-date qualifications, necessitate a
more result-oriented approach–a continuous credentialing/ monitoring of provider
credentials.
Continuous credentialing refers to a dynamic rather than static procedure ensuring an
ongoing validation of a provider's credentials whenever needed. Unlike traditional
methods of verification, leaving gaps in the process, regular practitioner evaluation
provides stakeholders with fewer risks of errors and guarantees patient safety. The
reason modern healthcare relies on continuous evaluation is more than a trend; it is an
adherence to quality assurance and regulatory compliance. Moreover, the healthcare
industry's tending toward more tech-driven practices has even increased the urge for
credentialing to be performed electronically and with automation methods–streamlining
the ongoing verification in healthcare organizations in an increasingly complex
environment. Statistics record that 85% of provider credentialing applications lack
critical information, wasting time, resources, and effort, along with payment delays.
Hence, it's time to turn manual methods into manageable credentialing with tech-driven
tools!
Stay with us to discover the different forms and features of credentialing necessary to
improve quality in care and healthcare operations. Moreover, this review offers guidance
on how continuous practitioner evaluation captures tech advances to turn care
complexities into simplicities.
Continuous Credentialing in Healthcare
The term continuous credentialing or ongoing monitoring in healthcare indicates a
growing emphasis on adopting Ongoing Professional Practice Evaluation (OPPE) and
continuous engagement models. It is the process of assessing and reviewing a provider's
performance over time. The objective is to determine whether the healthcare provider
adheres to the rules of compliance, maintains their privileges for care, and helps to
identify issues in the operations that may potentially impact patient care.
As per the principles of OPPE, healthcare providers must adhere to structured processes
that support early detection and performance issues that negatively impact patient care
outcomes. Following the ongoing evaluation method, data is collected both quantitatively
and qualitatively.
Quantitative data supports:
- Data in numerical forms and percentages
- The data include information on infection complication rates, hospital rules, compliance with regulations, and length of stay trends.
Qualitative data features:
- Data is collected through observations, discussions, and physician interaction.
- The information includes patient outcomes, documentation quality, types of procedures performed, and peer recommendations.
Continuous Credentialing Vs. ReCredentialing
Credentialing serves a positive role in maintaining the standards of compliance and professionalism in healthcare. However, stakeholders may often get confused with the terms continuous monitoring and re-credentialing by deeming these the same processes, but they aren't in actuality. There's a slight difference in both processes regarding the purpose and focus these procedures offer to the overall healthcare system. Nevertheless, the ultimate goal is to enhance patient safety and help practitioners maintain high-quality standards across healthcare settings. To make you more apparent on the characteristics of both procedures, here's the breakdown of key differences between the procedures:
| Continuous Credentialing | ReCredentialing |
The ongoing process of monitoring provider qualifications and performance
between formal credentialing periods
The steps included are:
|
Periodic reassessment of provider’s qualifications occurring at regular
intervals
The steps included are:
|
The need for transitioning: From Periodic to Continuous Provider Verification
The healthcare industry’s shift towards an ongoing procedure of provider verification is a significant contribution to the evolution–a successful evaluation of provider check aside, but other factors determined the need for why continuous monitoring mattered. Let’s figure out further:
- Increasing intricacy of healthcare environments
- Continuous credentialing ensures up-to-date information
- Ensures timely identification of potential issues
- Improved patient safety through regular updating and verifying provider credentials
- Healthcare organizations stay compliant with ever-changing industry policies
- Leading to cost-saving credentialing
Why does Continuous Credentialing matter in healthcare?
The guaranteed patient safety
Ensuring patient safety is the prime purpose of all providers’ efforts in healthcare. A
single error in treatment quality or record-keeping may significantly impact patient
trust with healthcare practice. With ongoing monitoring, practices can detect issues at
earlier places that could harm patient safety. For instance, malpractice claim reporting
and lapsed licenses. However, regular credentialing can ensure practices that qualified
providers are delivering the care.
To give you an example, a hospital has initiated provider credentialing to check the
physician licensure and their ongoing performance. However, the existing physician
lacked the updated licensure due to the temporary suspension. By immediate checking, the
hospital was able to suspend the physicians’ privileges while–securing patients from
potential harm and ensuring that the care was only delivered by the licensed provider.
Regulatory compliance with healthcare industry standards
Healthcare organizations need to fulfill the quality criteria set by the Joint Commission and the Centers for Medicare and Medicaid (CMS). Continual verification ensures that the practitioners meet those compliance standards at practice to avoid the risks of legal penalties. Example: A healthcare system is required to comply with certain standards of the Joint Commission to maintain an up-to-date record of each provider’s qualifications as regulatory requirements. By conducting continuous credentialing, the organization may ensure the passing of several unannounced audits to demonstrate compliance with set regulations.
Ensured operational Efficiency
Verifying provider credentials traditionally may cause various hurdles as it concerns data privacy issues plus, the credentialing process is resource-intensive. Handling personal and professional data efficiently poses many challenges for practitioners unless proactive measures for data security aren’t in hand. However, the shift towards continuous monitoring has helped practices in many ways such as streamlined credentialing with less administrative burden, and quicker provider onboarding especially when the provider volume is lengthy in an organization. Example: A large hospital network performs the shifted ongoing credentialing to reduce the additional administrative strain. By integrating automated alerts, the network could efficiently expedite the approach for new hires. It not only reduced the lengthy time required for providers to start work from month to week but also efficiently covered the staff shortages issue to ensure patient demands were met quickly.
The Tech-backing in Continuous Credentialing!
Overall, technology and automation have been a significant contributor to modern
healthcare practices' shift towards the sustained process of provider verification–the
reason is a risk-free and quicker process at less expense required! The healthcare
industry allocates approximately $89 billion, or 22% of its total expenditures, to
administrative transactions. However, by fully adopting electronic methods, including
provider verification, the industry can save $18.3 billion.
Once assumed as a time-consuming and tedious process, credentialing in healthcare has
become comfortable with the digital methods of data verification. Plus, the integration
of advanced technology such as electronic credentialing systems has created more
feasibility in continuous monitoring for practices to ensure all stakeholders have
access to the more current provider information. That’s not all but there is more in the
future for tech-credentialing!
The Future Focus!
With the non-stop advancements in technology and automation revolutionizing credentialing, practices and providers must turn their focus towards the efficient integration of these systems. For instance, Blockchain is a promising innovation in the future to convert the verification complexities into a streamlined process. Markets and Markets report that the global market size of blockchain is expected to grow from USD 3.0 billion in 2020 to USD 39.7 billion by 2025–a significant anticipated growth in credentialing applications!
Some of the crucial perks:
- Blockchain can provide decentralized space for credentialing
- The data stored in the system cannot be altered or tampered
- Reduced risk of fraud as credentials are verified and cannot be falsified
- The speedy and enhanced verification process
- Blockchain-based credentials are globally accepted
Final Thoughts!
With the increasing demand for adaptive procedures to ensure improved care and
compliance needs, healthcare keeps evolving the existing and introducing novel
procedures. Continuous credentialing is one of those innovations in healthcare to
support high standards of quality care and practice compliance. On the one hand, the
periodic procedure of credentialing serves long-term compliance while on the other,
ongoing monitoring is crucial to gain real-time results for provider performance and
maintaining care privileges. However, technology immersion has gained traction across
healthcare operations that trigger the need for continual verification as the process
has become smooth, easy, and error-free with other perks.
In spite of that all, TheCredentialing offers the true partnership! We provide you the
credentialing support with our integrated technology and automation tools to serve you
the best results.
Our Credentialing Services Include:
- Document Verification
- Pre-Screening
- Application Submissions
- Follow-Up Coordination
- Regular Bi-weekly Progress Reports
- Clear Communication
- Dedicated Point of Contact
- Streamlined Process
- Success of work
- Insurance Network Enrollment