How Healthcare Organizations Can Help New Providers Navigate the Credentialing Process

As they enter the final year of their Post Graduate Year (PGY) training, medical residents shift their focus to finding their first job.

How Healthcare Organizations Can Help New Providers Navigate the Credentialing Process

As they enter the final year of their Post Graduate Year (PGY) training, medical residents shift their focus to finding their first job.

 

The Association of American Medical Colleges (AAMC) predicts that by 2032, the demand for providers will exceed the supply by up to 121,900 full-time providers. Provider shortages mean there are plenty of job opportunities for new providers. According to a 2019 survey, 66 percent of medical residents completing their training received 51 or more recruiting offers.1 The demand for specialists is increasing, particularly in fields where shortages are occurring: surgery, psychiatry, geriatrics, and infectious disease. Higher demand can easily spiral into higher costs, especially as it pertains to provider sourcing and provider onboarding.

Since residents and fellows graduate at the same time, healthcare organizations can see hundreds of newly graduated providers being onboarded in the summer months. When you desperately need providers, you want to get them all credentialed as quickly as possible so they can start seeing patients right away. Most healthcare organizations can’t hire extra/temporary credentialing staff, so you must rely on existing Medical Staff to complete the process as quickly as possible.

This increase in workload can be mitigated without additional staff. You can maximize efficiency and accelerate provider onboarding by having streamlined, automated credentialing processes and a system in place that follows the regulatory requirements of your organization. You can enhance your brand’s footprint by engaging and educating new graduates about these processes. Furthermore, your ability to skillfully navigate and coach the graduates through the requisites of the onboarding process can attract candidates and help lower the administrative cost to your healthcare organization.

Many residents, who spend every waking hour caring for patients and completing other clinical duties, aren’t well prepared for the real-world job application process and the “business” side of medicine.

Over half of final-year medical residents (53%) said they received no formal instruction during their medical training regarding medical business issues such as contracts, compensation arrangements, and reimbursement methods.1  Residents should receive this instruction from their program directors, but the directors are often too busy attending to patient care and quality improvement to devote much time to administrative concerns.

The job application process requires more than submitting a curriculum vitae (CV) and acing an interview. Most residents applying for their first job don’t know what is required of them prior to and during the application process. So, offering residents much-needed help in navigating the onboarding process for their first job out of PGY training can be a critical first step toward positive physician engagement. Here’s how you can help them.

Helping New Providers Complete the Licensure and Credentialing Process

Educate new providers about the licensing/credentialing process so they know what to expect up front and can spend more time on your healthcare organization’s patient care mission and less time on red tape. New providers want to focus on patient safety/satisfaction, quality improvement, and meeting their clinical productivity goals as quickly as possible after they start their first job. 

Licensure. A state medical license is required for credentialing, so obtaining one is the first step. Licensure requirements vary by state, and the process — verification of vast amounts of paperwork by the Federation Credentials Verification Service (FCVS) — can take several months. Residents need to provide documentation of their education history — pre-med, medical school, Graduate Medical Education (GME; residency and fellowship training) — and licensure examinations. They should review the specific licensing requirements for the state in which they’ll be practicing.

Encourage residents to apply for state medical licensure early. Ideally, they should start this process in January of the year they graduate so they get their license in time to start a job in July. Knowing that a license usually takes no less than 60 days to issue from receipt of a completed and accurate physician application means a head start in saturated times like resident graduation can prove invaluable.

Credentialing. Provider credentialing — required for all hospital privileging and managed care payer enrollments — is a highly regulated process that involves verifying providers’ credentials at their original source to determine the accuracy of their qualifications. After the provider submits the credentialing application, the Medical Staff office reviews the documentation to be sure it is complete and accurate. The application is then reviewed by a peer review committee (e.g., a hospital’s division chief and credentialing committee or an outpatient group’s medical director and an internal review group). Automating and centralizing this process through a single source of truth can boost efficiency across all parties involved in onboarding a new physician.

Encourage new hires to start early. This credentialing process can take several months to complete, so newly signed residents should start gathering the required documentation and filling out the application as soon as possible. If they’re not properly credentialed, their start date may be delayed, and they may not be able to start seeing patients right away.

Provide a checklist of required licensure and credentialing documentation, including (but not limited to):

  • Driver’s license or passport.
  • National Provider Identification (NPI) number with current information pertaining to practicing specialty and taxonomy.
  • Board certification (or eligibility) status. If they’ve recently finished residency training and are waiting to take the exam(s) to complete board certification, they’ll submit a letter from the residency program director with their program graduation date.
  • CV (updated in MM/YYYY format).   
  • Peer reference information. They should gather the contact information of colleagues they can rely on for thorough and timely recommendations. This reference list can include training program directors and other clinical mentors.
  • Occupational Health Requirements: (e.g., TB testing and immunization history records).
  • Adult and Pediatric Advanced Cardiac Life Support (ACLS, PALS) certification.
  • Drug Enforcement Agency (DEA) license (required to prescribe medications). They should apply for their DEA license before their training DEA license expires, to avoid additional fees and/or paperwork. They must have an active state license to apply. Some states also require a separate state-controlled substance license.
  • Malpractice insurance coverage. They will need to provide proof and details of the malpractice insurance policy from their training programs.
  • Medical school and post-graduate training diplomas.
  • A copy of their Accreditation Council for Graduate Medical Education (ACGME) case logs. Many credentialing committees will request details about their case and patient load, including number and types of cases and sometimes a case log for procedures completed in the past year.

Help them complete the credentialing paperwork, ideally though a paper-free process to decrease potential manual error. Provide the checklists and walk them through the application. Have a consistently reviewed and refreshed FAQ sheet that can minimize unnecessary delays during the process. Designate an experienced staff member to assist during the completion of their credentialing application, to improve accuracy and compliance. By doing this, you’ll expedite the credentialing process and reduce the administrative burden on providers.

By helping newly signed residents efficiently navigate the onboarding process, you can prevent start date delays, maximize clinical training times, and enable new providers to begin seeing patients on (or close to) their start date. Having had a positive onboarding engagement and experience, new providers will be happy to be caring for patients, Medical Staff offices can maintain consistent output, and your healthcare organization can generate revenue sooner. Happier providers mean happier patients. 

TractManager’s Provider Management solution handles every component of provider onboarding, including credentialing, privileging, and payer enrollment. Having a partner that can compliantly expedite the provider onboarding process helps to launch a strong working relationship with all new providers.

For more information, download our credentialing white paper titled “To Delegate or Not to Delegate.”

Reference:

1 https://www.merritthawkins.com/trends-and-insights/article/surveys/2019-survey-of-final-year-medical-residents/

Author:

Allyson Schiff

Senior Director, Strategy & Growth, Provider Management

Allyson Schiff joined Newport Credentialing Solutions in 2009 and joined TractManager when Newport was acquired in 2018.

 

To Delegate or Not to Delegate – That is the Credentialing Question

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