Is Credentialing Important For Medical Practices? If Yes, Why?

Credentialing has become very important for medical practices. Credentialing is a process of verifying the professional portfolio of a healthcare provider. Medical practices and hospitals are now legally bound to verify the provider identity, educational documents, work experience, and license details. It has become a prerequisite by insurance companies to get the providers credentialed before submitting payment claims in their names. Medical practices are required to submit all the necessary documents to complete the credentialing of providers.

Credentialing protects from frauds

Credentialing is a systematic process of authenticating all the documents of a provider. When medical practices hire new physicians, then only by credentialing they can verify that all that is there on their portfolio is accurate and the physician has never remained involved in fraudulent activities. In many states, credentialing holds a legal status and it protects medical practices from lawsuits if anything goes against them.

Secure hiring process

The process of credentialing is usually performed when a new physician joins the practice. Credentialing allows the newly hired doctor to perform their duties as part of the medical practice. This is why most of the medical practices have made credentialing as an integral part of their hiring process. This helps them check the validity of professional documents of a provider which includes their license, educational documents, and past job experience. It makes sure that the provider is completely qualified to perform the job.

Improves practice revenue

If the providers and other staff of a medical practice are registered then they can positively impact the revenue of medical practices. Credentialing allows practices to accept all types of patients it increases their clients and revenue. Patients with insurance coverage tend to visit the same practice on follow-up visits. Credentialing allows physicians to treat patients with insurance coverage which increases the revenue of the medical practices.

Removes constraints

Credentialing removes restrictions that can limit the scope of practice. Credentialing allows providers working in a network to practice without limitations. Medical practices, which have onboard credentialed staff, can offer their services more openly to patients. If the staff of medical practice is non-credentialed then certain restrictions can limit their services.   

Improves reputation

Patients are more at ease when they know that the physician treating them is properly qualified to treat them. Credentialing enables medical practices to disclose the qualifications of the providers. It develops trust between patients and medical services providers when they openly disclose their professional experience. Patients, who do not know about the qualification of the physician remain skeptical and sometimes question the medical procedure performed.

Credentialing reduces errors

Credentialing reduces the possibility of errors as it ensures that only qualified staff is handling the clinical processes. A huge number of patients die every year due to negligence and due to some fault in the medical treatment provided. To curtail this, every practice should eagerly pursue credentialing which authenticates that the staff is qualified to handle the care delivery process. Medical practices should not limit credentialing to doctors and providers rather they must verify documents of the other staff as well. Medical assistants, nurses and clinical staff must undergo credentialing to help medical practices grow at full potential.