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INDUSTRY PERSPECTIVES: Top 3 Tips Every Urgent Care Must Know About Credentialing

Posted: Mar 4, 2019
Comments: 0
Author: UCA Admin

By Ted Gottis, Senior Vice President QuickCred, medtrainer

Healthcare has historically been behind the times when it comes to leveraging technology to provider credentialing.   Here, we will look at some easy ways to streamline the credentialing process and increase both efficiency and security.

Administrators spend on average 20 working hours in the onboarding and enrollment processes for each providers.  This process can routinely exceed over 6 months and $7,000 per provider.  Where could you spend this time and money if your process was more efficient?  Having a dialed in credentialing process positively impacts both revenue and patient outcomes.

The Urgent Care Clinic (UCC) sector is one of the fastest growing sectors in healthcare. Despite the aggressive growth trajectory of this sector, payer reimbursements have decreased while industry regulations continue to become stricter. This exponential growth has caused both an increase in government regulation and in competition. UCC’s need to understand how to leverage technology in order to survive and thrive in this highly competitive environment.  Superior credentialing methodologies are a key component of excelling in today’s market.

Here Are Our Top 3 Credentialing Tips.  

Tip # 1 Master Credentialing Checklist

Navigating the complex regulatory credentialing environment can be difficult. Any credentialing paperwork errors can result in major delays. A simple clerical error or oversight can stop payer reimbursement and affect your physician’s ability to practice and collect reimbursements from payers. Incorrect paperwork can also lead to liability breaches and loss of public trust. Our patients trust that all providers are properly credentialed and have been vetted.

A process rooted in paper has the inherent likelihood of clerical errors and data loss.  Alternatively, keeping organized records coupled with cloud storage solutions provides superior access and security. We also recommend keeping a Master Credentialing Checklist to increase security and efficiency. Rather than sifting through filing cabinets or excel spreadsheets, digital solutions allow for the convenient uploading of certificates, files, reference, accreditations you need in one centralized location. What this does is simplify your process and you can easily see any missing information or discrepancies in your paperwork filing. You can have peace of mind that your annual or semiannual credentialing can easily and accurately be completed.

Tip # 2 Virtual Credentialing Subject Matter Expert

Recently, Medicare began mass denying UCC’s payments due to a discrepancy in a new CMS rule on billing “new patients” vs. “existing patients.” This caused undue harm to many centers for not staying up-to-date on center compliance. Payments were delayed and ultimately can affect your standing with receiving Medicare payments. This type of regulation oversight can really impact the overall health of many UCC’s.

It is recommended to simplify your process with specialization in order to have the most effective credentialing.  It is recommended there be a subject matter expert who can field more complex credentialing questions.  This digital age makes it easier than ever to partner with credentialing specialist. Regulations are ever changing, and this allows your urgent care to have confidence you are operating in a culture of compliance.

What you don’t know can hurt your urgent care. It is best practice to have someone in house who specializes in credentialing or partner with virtual credentialing experts. This will ensure your revenue won’t be delayed due to compliance or credentialing error. Your organization will never miss timely and important federal or state regulation updates.

Tip # 3 Partner with a Credentialing Service Provider

The latest trend in effective credentialing is to partner with credentialing service providers. Free up your staff from the credentialing process by having a trusted company do your credentialing. Partnering with credentialing specialist can cut the credentialing process by weeks or months. You still have visibility and transparency of the process without the upkeep and management of it. Any error like incomplete work history, missing references, or outdated information can delay the credentialing process.

In some states they can take upwards of 60 days to notify you of an error. In the meantime, payers have stopped payment on that non-credentialed physician. How much revenue is being held for those two months? The investment in a credentialing company pays off in both revenue and time.

This is just the tip of iceberg for credentialing best practices. If you want to know more specifics like exact agencies you should be checking, most costly credentialing mistakes, and general tips we invite you to join the 2019 Credentialing Best Practices Webinar.

Join this live webinar to learn how to:

  • Defend against legal claims through proper credentialing.
  • Leverage technology to reduce payer enrollment processing times.
  • Create an effective credentialing management system.

Register Here.

These were just a few things to take into account with your credentialing process. We are interested in hearing what you think is most helpful in your center. Comment below, we will be sure to respond.

This blog article is a benefit of UCA's Corporate Support Partners (CSP) program. Thank you to MedTrainer, a Gold Level CSP.



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