Although rare, issues of malpractice, substandard care, and even the extreme case of “Dr. Death” are very real events that can happen in the medical community. Since the launch of the National Provider Data Bank in 1990, the American Healthcare System has made significant strides forward in regulating patient safety and increasing the availability of provider information.
Fast forward to today, and healthcare continues to bring new regulations forward. But with new requirements, comes more steps in the credentialing process; causing lengthy timelines, arduous paperwork, and sizable administrative staff needed to meet these rigorous standards. It’s safe to say, credentialing is a huge headache.
In fact, the credentialing bottleneck can soon add up to a multi-million dollar headache after you factor in the revenue you’re missing out on while providers are unable to see patients. When you couple this with huge provider shortages, and burnout at an all time high, this former back-office problem is now front and center at the executive table.
Putting provider experience under the microscope
Look closely and you’ll find credentialing is a long-standing burden for providers that is only tolerated out of necessity. To meet NCQA standards, providers need to be verified for federal and state licensure, DEA, malpractice history, board certifications, education, and more.
For many organizations, the work to do these checks and compile the associated documentation, is a manual process. Staff are going out to individual primary source websites, mailing information requests, making phone calls, and capturing data points to compile into a credentialing packet. If they’re not doing the work themselves, they’re likely outsourcing to a pricey CVO (Credentialing Verification Organization) to do the work for them.
But what does this have to do with provider experience?
According to a 2020 survey of physicians, 50% say the most rewarding part of their job is either the relationship with their patients, or knowing that they’re helping others.
Providers going through their onboarding process, excited to start delivering care to patients, are frustrated, and stuck waiting. They can be stuck in this credentialing bottleneck for as long as 45-90 days, due to the level of manual work involved.
The role of automation
The tricky part about credentialing is that parts of the process require expertise and critical thinking to review for quality assurance and decision-making, while other parts are tedious and time-consuming. The largest time factor in those tasks is primary source verifications (PSVs); where a credentialing specialist confirms provider licensure, certifications, and more from the originating source.
The availability of information has greatly increased over time, with many of these details now available in digital databases; making these verifications a prime candidate for automation. When PSVs are automated, credentialing time is drastically reduced from weeks to minutes. In addition, the credentialing process is less prone to human error, and organizations can be more confident when it comes time for audits.
Credentialing’s impact on your bottom line
Manual credentialing is known for being inefficient, but what most don’t realize is the impact it has on revenue. It’s as simple as this: when providers can’t see patients, they can’t bill for services. One family medicine physician generates an average of $5,800 per day, according to the 2023 AMN Healthcare billing report. When providers are stuck in the frustrating credentialing bottleneck for 45 days, that quickly adds up to hundreds of thousands, even millions of dollars, of lost revenue.
When primary source verifications, packet creation, data entry, and follow-ups are mostly automated, the credentialing timeframe can take as few as 10 days or less.
Once credentialing timelines decrease, providers start seeing their patients sooner, building relationships and feeling the satisfaction from their job. Patient wait times are alleviated by increased provider bandwidth for care delivery. And finally, thirty-five days of missed revenue can now be recognized - for one family medicine physician that’s around $203,000.
The Verifiable difference
Verifiable is the leading solution for automated primary source verifications, and provider network management. The unique technology integrates over 3,000+ sources to complete PSVs according to NCQA standards, with the click of a button. Healthcare organizations of all shapes and sizes use Verifiable to credential 4X faster, take control of their provider data, and create an experience that providers respect and appreciate.