The credentialing profession is about consistency. Regulatory and accrediting agencies mandate a set of criteria. All we have to do is follow that criterion to the letter. Sounds simple, right? To the individual unfamiliar with that simplified criteria, yes. The first impression would be to follow the directions to create a successful program. However, those of us in the profession know that the process is anything but simple.
Collecting and verifying data may be the easy part. What you do with that data is the complicated piece. That is what defines the credentialing process; doing what needs to be done with that wonderful data. Every healthcare organization that hires or contracts with a healthcare provider is tasked with more than just collecting data on or from these individuals. It is the organization’s responsibility, not only to keep track of that data, but to analyze it, approve it, re-assess it periodically, monitor it, and improve upon the processes continuously. That is why it is essential to have a seasoned professional or a professional dedicated to learning the nuances of credentialing leading the charge to establish and maintain a consistent and compliant program.
What is a consistent program? One that operates near flawlessly. The program based on consistency has a well-defined structure, a trained staff, and a database that supports staff productivity. Think about what consistency means. The word is defined as conformity in the application of something or that which is typically necessary for the sake of logic, accuracy, or fairness. Doesn’t that describe credentialing? Its logic is to ensure providers are competent and qualified to deliver healthcare services. Accuracy is key in the credentialing process, getting the right data the first go around documented accurately and in a manner that treats all providers fairly and equitably. Maintaining a consistent credentialing program is key to keeping your organization alive. It is your responsibility to make sure it's providing the services it promises from the clinical providers you have credentialed. For an effective credentialing program, don’t fail to practice consistency.
Dilsa S. Bailey, CPMSM is the owner and principal consultant for The Right Credentials Network. She specializes in training and consulting in the medical services profession, including credentialing, payor enrollment, and provider data management for all healthcare institutions.