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Provider Credentialing Biggest Issue for Medical Practices

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Having a team of credible health care providers that is up to date on their credentialing is essential for worker efficiency within a medical practice. Without all the essential credentials, staff is not permitted to aid in any medical services. This can lead to a variety of issues for the practice itself, including lost productivity and revenues. Many of the issues with credentialing deal with a lack of organization. Unfortunately, many medical providers have busy schedules. This ultimately prevents the medical provider from keeping their credentials up to date. Other issues include timing and state compliance.

Credentialing Timeline

Many times, insurance carriers claim that it takes around three months to approve credentials. However, this is the minimum amount of time it takes. By the time it takes the carrier to approve credentials, the old credentials may have already expired. This could put a medical provider out of work for a period of time, leading to lost productivity. In order to avoid this, medical providers should submit credentialing paperwork early. This ensures that credentialing does not expire, even if the carrier takes the maximum amount of time for approval.

State Compliance

Another important thing to consider is the different compliance laws in each state. Some states have different credentialing requirements; therefore, it is important for the employer to identify any differences when hiring an out-of-state physician. Knowing the state’s compliance laws allows a health care provider to fill out any necessary credentialing paperwork before starting the job.

Tips to Properly Complete Credentialing

Credentialing is an ongoing process; therefore, it is crucial for a health practice to remind health care providers to update their licenses and credentials. One way to ensure that credentialing is updated is by assigning a team member to handle it. This individual will ultimately be responsible for notifying each employee when they need to file important documents. This ultimately keeps everyone on schedule, ensuring compliance. Doing this can alleviate stress and ultimately allow the professionals to focus on caring for their patients.

Another tip is to perform private background checks on health care providers. This may seem over the top, however, doing private background checks helps prevent a variety of problems. It allows the employer to verify any relevant history before receiving carrier approval or denial.

Philadelphia Physician Lawyers at Sidney L. Gold & Associates, P.C. Help Physicians with Credentialing Issues

If you are a physician that is dealing with compliance issues, including provider credentialing, contact a Philadelphia physician lawyer at Sidney L. Gold & Associates, P.C. Our lawyers understand that the health field is rigorously monitored. Therefore, keeping credentialing up to date is important. If you are interested in consulting with a physician lawyer, contact us online or call us at 215-569-1999 for a free consultation. Located in Philadelphia, we proudly serve clients throughout Wilkes-Barre, Scranton, northeast Philadelphia, Bucks County, Chester County, Delaware County, and Montgomery County.

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