To Delegate or Not to Delegate -That is the Credentialing Question
A white paper by:
Vice President of Credentialing
Sr. Director, Strategy & Growth
Credentialing is one of many quality management tools that healthcare organizations implement to monitor patient safety. While most will agree that it plays a valuable role in establishing and governing high-quality provider networks, very few appreciate its impact on strategic growth opportunities, revenue cycle management, and data integrity.
In fact, credentialing is an area of healthcare operations that is often overlooked in enterprise-wide strategic planning. It isn’t until delays and backlogs result in serious financial and administrative woes in the form of bad debt or frustrated providers that most organizations will approach the topic. Even then, it’s usually with great trepidation and uncertainty.
The truth is that there is significant risk associated with provider credentialing — failures of credentialing have been linked to large malpractice suits, some of which set the legal precedents for the credentialing laws and regulations in place today. And while the fundamental structure of evaluating competency and qualifications
remains unchanged across organization types, variations in regulations between state, federal, and accrediting bodies render already complex procedures nearly impossible to absorb.
Why would any health system or provider network want to take this on?
Because an effective credentialing program has proven to be successful in facilitating rapid network expansion, shortening provider onboarding timeframes, improving quality and data management processes, increasing contracting leverage with managed care partners, and significantly enhancing the health of the revenue cycle.
How would any provider network take this on?
In this white paper, we will establish a common understanding of credentialing, underscore the benefits and risks of delegated credentialing, and provide a roadmap for organizations interested in expanding into this critical area of healthcare.