Credentialing Corner

# The Importance of Continuous Monitoring in Credentialing

- May 28, 2024
- Posted by Kristen Edwards

02 Oct

The credentialing process is complex, having many elements, all of which work together to make the whole process smooth and streamlined. All of these elements are verified at one point or another during the professional career of the practitioner. Some elements are only verified once during the initial employment of the practitioner. In contrast, some others, like specific training licenses and certificates, must be monitored continuously and regularly throughout the practitioner’s career.

This continuous monitoring of these credentials is important because it allows the healthcare facility and the credentialing authorities to see if the doctor maintains the standards set by the healthcare codes. This ongoing monitoring is also important for providing claim reimbursements to the doctor. It also reduces the risk of malpractice and fraudulent activity within healthcare centers as practitioners perform their duties vigilantly to keep a good profile in the eyes of credentialing authorities.

Today, we will look at some parts of the credentialing process that need continuous monitoring. We will also discuss the importance of this continuous monitoring process and how it allows healthcare facilities to provide quality patient care.

## Continuous Verification in the Credentialing Process

The ongoing monitoring process can be complex, especially in healthcare settings where many parties, including the doctor, patients, insurance agencies, and healthcare facilities, are involved. The whole process of this continuous survey of the doctors’ progress consists of identifying, isolating, mitigating, and controlling any risks posing a threat to the provision of adequate healthcare to the patients. Any risks that can damage the doctor’s integrity are also identified and controlled so that the doctor can act according to standards set by the US healthcare system.

The complete process of continuous monitoring of medical practitioners consists of several important steps, some of which include:

### Inspection of Standards and Risks

This is the first step in the monitoring process in which the authorities check if the doctors are maintaining the standards set by the US healthcare system. This process also checks any potential threats to damage the integrity of the doctor and the healthcare facility. These risks might be lapses in the transaction fees between the clients and the healthcare facility. Any malpractice done by the doctors is also identified and looked into. Some of the credentials of the doctors, which are continuously monitored and checked to ensure that everything is up to the mark, include:

- Expired certificates
- Insurance liabilities
- Licenses and certificates
- Medicaid references
- Board reviews

### Control of the Risks

Once the standards are checked and the risks identified, the credentialing authorities implement specific steps to control any lapses in the credentials of the doctors as well as any risks hampering the provision of quality healthcare to patients.

Some ways to control these risks are:

- Implementation of strict standard procedures
- Checking the performances of doctors according to set metrics
- Regular quality assessments and improvements
- Peer reviews
- Regular audits
- Compliance checks.

### Investigations

Continuous monitoring keeps the number of performance and compliance breaches to a minimum. Still, sometimes the risks can also become serious and hinder the course of provision of quality healthcare to patients. If lapses are decided in any of the areas mentioned above, the credentialing authorities perform investigations to identify the root causes of these lapses. The authorities might look into doctor and healthcare facility information and identify potential breach areas.

For example, sometimes the claim reimbursements of the doctors don’t come through. The monitoring authority investigates this issue and identifies some of the expired licenses and certificates of the doctors. In this case, the authorities alert the doctor of the issue, and the doctor takes further action to solve the problem.

### Reviews and Reporting

Once the whole monitoring process is completed, the monitoring team reviews the whole situation of the doctors and the healthcare facility and provides a detailed report of any areas of potential weakness. The teams also review the job done by themselves by using pre-made and standard Performa to ensure that they have complied with all rules and regulations of the monitoring process.

## Why ongoing Monitoring matters in Healthcare Credentialing

singularityhub.com

Ongoing monitoring has become one of the most integral parts of almost all healthcare settings and has contributed significantly to the provision of quality healthcare to patients. Ongoing monitoring is important in the credentialing process and matters in healthcare settings because it provides the following:

### Patient Safety

Ongoing monitoring points the credentialing teams to any areas of concern in the performance and behavior of the practitioners and allows the teams to detect any lapses in the job and duties of practitioners. If any lapses are identified, the monitoring teams alert the doctor as well as the healthcare facility to control the lapses and implement specific systems for their control.

This rapid provision of insight into the mistakes and lapses of the doctors allows the hospitals to respond immediately and prevent any patients from getting substandard care. Thus, This process translates into better patient care and ensures safety.

### Quality Maintenance and Improvement

Regular checks into the practitioners’ credentials allow the healthcare facilities and monitoring teams to be on the lookout for any areas of improvement within these credentials. Once these improvements are brought about, the whole caretaking process improves by significant margins, and the overall quality of care provision to the patients improves. This improvement, in turn, allows healthcare facilities to provide better care to patients.

### Compliance with Up-to-date Guidelines

The healthcare system is continuously being upgraded with new and improved patient treatment guidelines. New and better standard procedures are also being implemented to ensure doctors adhere to the treatment guidelines and treat their patients best. The healthcare facilities themselves have to follow these up-to-date guidelines. Continuous monitoring allows these facilities and the practitioners working within them to be aware of and obey the most recent guidelines.

This obeying of the updated guidelines is important for healthcare facilities and doctors alike, not only because it allows them to provide quality care to patients. Obeying these guidelines is also mandatory to prevent any chances of getting fined.

### Management and Control of Risks

Doctors responsible for undergoing continuous improvement are also aware of the risks associated with errors in their credentialing process. Moreover, they are also aware of the chances of malpractice and adverse actions that can be taken against them for their ignorance of the credentialing guidelines. This awareness allows them to correct the errors and be mindful not to repeat the same errors in the future.

This awareness ultimately translates into fewer chances of any mishap or lapse on the doctor’s part, which may result in legal claims or lawsuits against them. Thus, the doctors can steer clear of any legal action against them.

## Keeping Credentials Updated: The Importance of Monitoring

3xi.org

Considering all the points mentioned above, doctors must take special care to keep their credentials up-to-date and submit themselves to continuous monitoring regularly. In addition to the things mentioned above, continuous monitoring can also be important due to the following reasons:

- Practitioners become mindful and accountable for their actions
- Practitioners strive for betterment and greatness in their work
- Practitioners and healthcare authorities maintain ethical and legal integrity
- Prevention of bigger issues in legal and ethical review boards
- Practitioners can develop themselves professionally by maintaining practice standards
- Doctors can identify areas of improvement within the healthcare system and can contribute to betterment.
- Healthcare facilities can prevent lawsuits and legal action against them.

## Conclusion

Ongoing monitoring checks the dynamic elements of the credentialing process, which must be verified at regular intervals throughout the practitioner’s career. These credentials are essential for doctors to provide continuous patient care. Through a complex process of identifying, isolating, investigating, and mitigating risks, ongoing monitoring allows credentialing teams to check for any areas of potential breaches and lapses in following standardized guidelines set by the US healthcare system. These checks and balances then improve practitioners’ performances and remove any practitioner found guilty of gross violations.

The credentialing process is important because it allows healthcare facilities to provide better quality care to patients and ensure their safety, control legal and ethical risks and lapses, comply with up-to-date healthcare guidelines, and maintain new and improved standards for practitioners to follow. Since the ultimate goal of the US healthcare system is to provide better care to patients, continuous monitoring acts as an important pillar of the complex healthcare system. It allows the doctors to perform to the best of their abilities to reach the ultimate goal. Thus, ongoing monitoring allows healthcare facilities to make the world better for patients through small but steady steps.

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