Credentialing Corner

# How Can Medical Credentialing Services Benefit Your Practice

- January 13, 2025
- Posted by Kristen Edwards

08 Mar

In this ever-evolving world, healthcare providers and patients want a safe and reliable system for healthcare provision. Medical credentialing is the only way to ensure a desired healthcare system in which professional physicians are hired and high-quality treatment is given to the patients. Medical credentialing is not only for patients but also for doctors. Medical credentialing plays a vital role in the booming medical practice of healthcare providers.

This article will discuss the benefits of credentialing healthcare physicians in their practice and its advantage in making the treatment process safe and satisfactory.

## What is medical credentialing?

Credentialing is a process that verifies the competence and qualification of practicing clinicians, thus ensuring safe and effective patient care. This includes certification and verification of credentials for education, training, work history, licensure, certifications, disciplinary actions, and malpractice claims.

A healthcare provider typically initiates credentialing by applying for hospital privileges, clinic access, or network insurance participation. The committee may contact the provider’s educational institutions, previous employers, and licensing boards to confirm the truthfulness of the information. When the committee finishes with the investigation, the committee recommends acceptance or rejection of the provider’s application.

Below are some benefits of medical credentialing:

### 1. Quality Assurance

The medical credentialing process delivers quality control in the healthcare industry. It is a way of monitoring the healthcare industry and providing assurance that excellence in medical quality is adhered to for the benefit of patients. To maintain insurance costs, insurance companies tend to value only medical physicians and practices that have demonstrated that they can successfully do the work in their specialist areas.

### 2. Patient Safety and trust

Credentialing also helps protect patient safety by assuring physicians have the experience and skills to perform sensitive patient procedures. The procedure helps to minimize the possibility of incorrect care that can occur in the process that incompetent health workers might carry out. Patients and physicians need a strong bond to be restored, and trust can be rebuilt with the quality care assurance presented by credentialing.

Patients who understand that their physicians have the merit and qualifications of being the personal choice of provider could do so confidently by placing their highest trust in them.

### 3. Increase revenues and reimbursement.

Proper credentialing will allow medical practices to recover from thousands of dollars lost in revenue due to delays or denials of reimbursements. Providing adequate credentialing by the clinician or due to some mistake in the process can allow insurance payers to reimburse medical practices for their treatments. When a medical practice allows a physician to provide services before or during the credentialing process, the insurance payer can ‘backdate’ reimbursement to cover those treatments.

### 4. Patient base expansion

Physician credentialing allows medical practices to have patients from sources not previously available to them, enabling facilities to receive patients whose payments are covered by health insurance. Over 90% of Americans had health insurance in 2019, with more than 60% having private health insurance. This strategy helps medical practices to increase their customer base and to diversify their revenue sources.

### 5. Reputation Enhancement

People always look for information in healthcare practices or their physicians before making up their minds. This could manifest by looking at their social media accounts, background, or online patient reviews. Obtaining medical credentials is a great option to build your online reputation. When your potential patients start exploring your medical practice and seeing the list of your credentials, they can see that your practice is qualified, reputable, and trustworthy.

### 6. Streamlined hiring

During the credentialing of a doctor, they have to undergo a strict process of examining the place where they’ve lived, their educational background, their work experience, and if they have any other advantages. Suppose you originate from the field of medicine and, hence, require a credentialed medical practitioner. In that case, this accreditation identifies if the doctor meets the criteria needed to perform the job description tasks.

### 7. Competitive Edge

To remain competitive in a challenging healthcare environment, medical practices must find the best ways to separate themselves from any other practice. The verification process identifies you as a qualified healthcare provider for the specific field, and this helps the patients distinguish you from other healthcare providers specified in different fields.

Also, having been certified can attract qualified tenants attached to a credentialed practice with a more extensive community of patients to your practice. The referral process known as medical credentialing gives your practice an advantage over those not in your market, giving you more time for growth.

### 8. Reducing medical errors

Credentialing Leads to a Decrease in Risk of Errors by Health Care Providers

The medical gaffe (medical error) is the leading cause of death in the country due to negligence, more than all the causes of accidental death combined. These errors were responsible for the death of around a quarter of a million people annually during the first decade of the 21st century on average. More than that, it was enough to make medical malpractice the third cause of death in the US, behind cardiac problems and cancer.

Credentialing of healthcare providers mitigates dangers arising from incompetence in providing healthcare services. Credentialing assures a provider’s qualifications and professional history by verifying these through verifying the provider’s credentials. This depreciation reduces medical mistakes in many forms, like miscommunications, physician-ordered prescription errors, adverse drug interactions, incomplete patient medical records, packed health facilities, understaffing clinics, and improperly managed and overly complex workflows.

## What is medical credentialing for insurance companies?

A critical process that every healthcare provider must pass before they can charge insurance companies for their services is their credentialing. Each insurance company must complete this process (known as insurance credentialing) for which a provider would want to receive payments. To illustrate, imagine a healthcare facility wishing to take insurance coverage from around ten insurance firms. This means that those providers who work in this facility must do the credentialing process ten times.

Several requirements for health practitioners’ credentialing exist, and the standards can vary depending on an insurance company. However, most insurance organizations will ask practitioners to provide certain documents necessary for credentialing verification. These include:

1. Identification and citizenship.
2. Desirable training and education first.
3. Licenses issued
4. Licensing or qualification to practice in their particular healthcare zone.
5. School attendees, test scores, and degrees received from academic history
6. Desirable dates for the remaining points are also provided

As well as this essential data, insurers could request additional information on the doctor’s work experience, results, and violation of medical standards.

The information is even more detailed for Medicaid and Medicare, the largest groups of licensed health professionals. Additionally, the requirements, standards, and criteria for credentialing can differ for each insurer from one credentialing period to another. Therefore, before screening begins, doctors must check what changes the health insurance company has made during those years. Medicaid and Medicare have the changes more often. During verification of adherence, they might even show the need to be credentialed in advance.

## Conclusion

Medical credentialing systems are of great importance since they function as a regulating mechanism for the availability of health practitioners in healthcare organizations. Credentialing could create patient trust and reduce administrative efforts. Indeed, the benefits of credentialing start with the credential holder and reach so many other elements of the health organization. The practice can fund credentialing services to comply with regulatory standards, limit risk and liabilities, and attain better patient outcomes and satisfaction.

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