Why credentialing should be on your New Year’s resolution list

The financial repercussions of expired credentials can be substantial. After all, when providers’ credentials expire, they will not be paid for the procedures they perform. Some plans, such as New York State Medicaid, will go so far as to remove a provider from their plan if a license is expired. For a hospital or health system with hundreds, sometimes thousands, of providers, lost revenue resulting from the inability to bill a case can quickly add up.

With the ramifications of expired credentials well known, it is surprising how many hospitals lack an organized, automated way to manage credential expiration dates. To help hospitals regain control over credentialing expirables in the coming New Year, Newport Credentialing Solutions’ Vice President of Operations, Allyson Schiff, shares the following tips.

1. Identify all documentation that has an expiration date. Unlike a car registration reminder, most credentialing organizations do not send a note alerting providers to an impending expiration date. Therefore, it is the provider’s responsibility to manage expirables. The most common documents with expiration dates, for enrollment purposes, are provider licenses, DEAs, board certificates, liability sheets, hospital appointment letters and any additional certifications a provider may have. Knowing what documents expire, and being aware of impending expiration dates ahead of time, means you won’t be chasing things after the fact. Furthermore, when contracting with a health plan, make sure you understand their terms in regards to renewing expiring documents.

2. To ensure expirablescan be easily monitored, information should be housed in a central, cloud-based repository and available for review on a real-time basis. The ability to quickly pull reports at the end of each month which indicate upcoming expiration dates is key, especially for larger hospitals and health systems with a significant number of providers. This technology should also allow automated reminders to be set alerting credentialing staff to impending deadlines. With information in hand, staff can reach out to providers to obtain new items/current versions in a timely manner.

Whether managing credentialing in-house or working with an outsourced partner, it is easy for expiration dates to fall through the cracks. Manually monitoring this process can be a very time-consuming and complex endeavor. Because the credentialing life cycle has so many moving parts, having the right processes and cloud-based technology will play a pivotal role in ensuring no expiration dates are missed. With the right processes and credentialing technology in place, lost revenue due to missed expiration dates can be eliminated. Want more credentialing tips, contact me at Allyson.Schiff@newportcredentialing.com.

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