Guest blog by Mike Simmons, CEO of CredSimple
Telehealth continues to emerge as an important sector of the healthcare industry but the industry is still working to implement regulations that reflect this new area of patient care. In the interim, proactive telehealth companies will see many advantages to installing a medical credentialing process before outside authorities mandate it. And the good news is, with today’s technology, you don’t have to be bogged down by the manual processes and long turnaround times of the broader healthcare industry.
Reason 1: Protecting Clients
Credentialing is a rigorous process that ensures doctors have the background and skills they need to care for your patients. Without a defined credentialing process in place, you could be referring your clients to doctors who have let their medical license lapse or who, for other reasons, are not qualified to see patients. Having a network of doctors you know you can trust is the most valuable asset a telehealth company can have.
If your clients knew they were choosing between a telehealth provider that puts their doctors through a rigorous process that ensures they have the background and skills they need to care for patients or one that doesn’t, which would they choose?
Reason 2: Protecting Your Business
How comfortable are you with the answers to the following questions:
- How many of your providers are board certified?
- Do any of your providers have any criminal history?
- How many of your providers have medical malpractice history, and have you reviewed these cases?
- Do any of your providers have outstanding disciplinary actions by state licensing boards?
- Do any of your providers have expired licenses?
- Do your providers have an active DEA license to prescribe medications?
A simple yet rigorous credentialing process ensures that no provider falls through the cracks and exposes your organization, or any of your patients, to any risk. By waiting for compliance to be mandated by authorities such as the National Committee for Quality Assurance (NCQA) and the Joint Commission on Accreditation of Healthcare Organizations (TJC), you’re exposing your organization to risk and liability.
Reason 3: Outpace Your Peers and Differentiate Your Brand
Now is the time — credentialing puts your members first and will differentiate you from your peers. And with CredSimple’s automated credentialing process, you will be lightspeed ahead of the industry standard for credentialing turnaround times and data accuracy.
Considering how simple it can be to credential a doctor with cloud-based credentialing software and services, there’s no reason for letting your provider network grow without a having a robust NCQA-level credentialing process in place. Even if you are not yet a national brand, it’s easy to get started with credentialing, and it should be a priority for any company. Why take needless risk with your clients’ care, your providers, and the reputation of your brand?
Here is a checklist of what to look for when choosing a credentialing solution:
- Fast and accurate verification of primary sources
- Digital application that is provider-friendly, quick to complete, and doesn’t ask for the same piece of information twice
- All digital (no paper files to organize or wade through)
- Multi-specialty ready (can handle all provider types – MDs, DOs, PAs, and more)
- Multi-state & national coverage
Ensuring that all providers meet credentialing standards is good business and standard industry practice.
Check out how WellVia grew its network recruit a national network of doctors because of our simple credentialing process.
CredSimple is an NCQA-certified CVO and the only credentialing solution that can deliver a five-day turnaround time and accurate provider data that is useful to downstream functions such as billing claims, provider directories and business intelligence.
Medical billing and credentialing for medical providers are two different categories in the healthcare world. Before any medical billing can even be completed, the healthcare provider needs to be credentialed with insurance companies in order to be an approved provider of services. Becoming credentialed as an in-network provider dictates the set amount of reimbursement that provider can expect back.
After the credentialing process has been completed the healthcare provider is then able to start treating patients in that network and sending claims for reimbursement. A medical biller will use CPT and ICD-10 codes on the claim to describe to the insurance companies what treatment the provider has given. They will then follow up on the claim to make sure that it has been properly paid by the insurance company.