How Medical Credentialing Improves Patient Safety?

The term medical credentialing is not new for many of us. It is defined as the process of collecting and verifying the practitioners’ qualifications and credentials, be it their license, education, training, experience, and more.

Why are Healthcare Organizations Credential Their Resources?

Most hospitals and private clinics already authenticate their resource qualifications at the time of hiring.

The reason is to get insight into if the doctor or nurse is qualified enough to manage the complex operations. Moreover, medical credentialing also help to assign privileges to physicians. Generally, medical billing companies are responsible for managing these operations. 

Qualified Physicians Prefer to Credential Their Training 

A clinician who is credentialed from a professional company gets more advantages than a non-credentialed doctor does.

For instance, they can easily pass for the insurance company’s network. They get timely reimbursements from payers. They get to increase their patient volume and more.

Studies show that most credentialing procedures are done before the resource is granted any privileges.  

So, what does it have to do with patient safety and outcomes?

Of course, a qualified clinician ensures all the safety measures that are necessary to treat patients. They provide quality care and promote interoperability to facilitate patients.

Let’s go through the credentialing process in detail to know about its various sectors.

• Verification of medical training and education

• Check the authenticity of medical licenses

• Verifying the list of Medicare/Medicaid enrollment

• Looking for any misconduct of privileges in the track record

• Investigating any malpractices in disciplinary actions

• Verifying the Drug Enforcement Administration Certification for doctors 

• A verifying physician from National Practitioner Data Bank

• Consulting American Board of Medical Specialties and other qualified boards

Now, we know what factors go down in the medical credentialing list.

Let’ see the impact of medical credentialing on patient safety and outcomes.  

The Impact of Credentialing Services

Truth be told, credentialing does not happen in a day or two. This detailed process adds to the credibility of doctors and the medical practice.

Another advantage is healthcare organizations avoid liabilities that dent their reputation with false practices.

Verified Training Lead to Reduced Risk of Patient Misconduct

Patients trust doctors with their life. They assume that their respective doctor is capable of treating their illness and can bring them back to recovery without worsening the case.

Medical credentialing services put a stamp on this trust. The verified experience allows the administration to expect only value-based healthcare for the patients. Ultimately, patient outcomes and their safety are not compromised.

Medical Credentialing Helps Fills Gaps to Prevent Revenue Loss

Apart from verifying the doctor’s information, another purpose that medical credentialing services serve is compliance with the government rules and regulations.

We see many claims getting denied each year just because of minor issues. Other than risking timely reimbursements, clinicians can be fined due to fraudulent activities. Thus, monitoring in this regard is crucial. After all, patients’ lives are at risk. Especially, the government encourages healthcare organizations and medical billing services to get their physicians credentialed after two and a half years, which is an official period for re-credentialing.

Also, look for the list of excluded Individuals and Entities (LEIE) from the office of Inspector General’s (OIG) to ensure that no individual dents the reputation of your practice.

High-Quality Patient Care

Consider a scenario if a physician lies about his qualification and experience or simply exaggerates about it, they can endanger a patient’s life. Especially, in the case of life-threatening conditions, an unqualified and unconfident clinician adds more complexity to the case.

Another perspective is, if a patient gets hold of any complication caused by the physicians, they can be charged with a serious felony. In such cases, the incompetency of physicians also falls on the shoulders of hospital administration.

Thus, negligence in medical credentialing can also cause serious damage to a practice’s financial matters. They might have to pay for exposing patients to dangers.

Conclusion

Not every patient has access to minor details of the doctor’s background. So, when medical billing companies look into a physician’s background, they get even the hidden information. For instance, did the physician showed any worse behavior at their previous workplace? Or, what they claim about their medical expertise is true or not. In the worst-case scenario, the patient's life can be at stake. 

Holistically, when a patient enters a medical facility, it pertains to the hospital’s reputation. If a doctor has a bad reputation, the hospital might not grant them privileges as it can dent their reputation in the community, and can threaten someone's life.

Of course, patient safety is the most crucial factor that lays the foundation of the progressive healthcare industry. The payment incentive program - QPP MIPS also emphasizes quality care that also covers patient safety.

Thus, medical credentialing services have become a need for an empowered medical practice, which reflects on the improvement of their revenue cycle management and ensures patient quality outcomes.

Read more: What Future Holds for Quality Payment Programs?