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  • Dilsa S. Bailey, CPMSM

Six Ways to Maximize Your Credentialing Program



Over the past twenty years, I have witnessed and encountered some of the best, some of the worst, and some of the strangest credentialing programs. That’s why I enjoy helping organizations pull together a successful, streamline program that should almost run itself with the right tools and the right staff. But, first things first. To thrive the organization will need to develop a sound structure and foundation for credentialing. Here are six recommendations to make sure that program is on the right journey to success.

  1. Know the rules. Make sure your criteria are in sync with not only your accrediting agency but the state and federal agencies mandated for your organization type as well.

  2. Follow your rules. Don’t continuously adapt to various situations. Be consistent and yes, rigid.

  3. Keep your processes simple. Think of the acronym KISS, but cross the last S if you don’t like what it means. That especially applies to your re-credentialing cycles; you shouldn’t have to stop and think the odd number, even number months, birth dates, social security numbers, this section of this department, etc. Calendar dates are easier to maintain. Okay, maybe hospitals with large departments may benefit because of staffing. Toss the others.

  4. Train. Train. And train your staff again. Your employees need to know more than just the rote activities of verifications and collections; they need to know the why they do what they do and why it is so important. And let’s not forget those newbies you hire without any credentialing or medical knowledge as their background. There is a reason we assign specialties. And, yes there is a difference between an orthodontist and an orthopedist.

  5. Don’t just train your staff. Keep abreast of the rules. Join a professional society or create a mastermind group with organizations to help support each other. Plus, make sure you are efficiently networking in your own organization so that the Compliance or Quality Director doesn’t forget to include you on bulletins from those accrediting agencies or CMS.

  6. Don’t do ongoing monitoring yourself unless you have a dedicated IT staff that knows how to manipulate large amounts of data. Invest in the software that will do it for you or the vendor that does it ALL, not parts and not for only a particular set of providers.

Incorporate these steps into your everyday goals and you will pass every survey and every audit with ease. Even better, you will have a happier staff who will appreciate the support!

Dilsa S. Bailey, CPMSM is the owner and principal consultant for The Right Credentials Network. If you are interested in maintaining or applying for NCQA accreditation related to credentialing, contact her for more information. Dilsa helps to build and repair credentialing programs and trains staff to perform efficiently and productively.

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