Tag: Verisys

Eight Common Physician Credentialing Mistakes

Charlie Falcone

By Charlie Falcone, CEO, Verisys.

If you find credentialing uninspiring, consider this cautionary tale. In a frequently cited negligent credentialing case, an Illinois jury awarded the plaintiff nearly $8 million dollars when the patient’s foot had to be amputated due to damage caused by the operating physician who had not completed his 12-month podiatric surgical residency and was not board certified.

Although physician credentialing may seem like a tedious administrative task, poor execution can result in serious consequences. Credentialing mistakes lead to financial losses on provider services, delays in claim reimbursements, fines or penalties, exclusion from federally funded programs, and harm to patients. Credentialing lapses can expose a healthcare organization to malpractice suits and accreditation problems. Deviating from best practice credentialing procedures puts organizations at risk for claims of negligence that could allow a lawsuit to move forward.

Best practice physician credentialing is the process in which a practitioner’s credentials are obtained, assessed, and fully verified. The proper credentialing steps can be complex and time-consuming but are a fundamental responsibility of hospitals and healthcare facilities.

To mitigate risk to your organization, avoid these eight common physician credentialing mistakes made by practitioners and the facilities that credential them.

Mistake No. 1: Relying on limited staff and administration.

Physician credentialing, also known as medical or provider credentialing, is a laborious process that requires precision, attention to detail, and patience. All certifications and licenses must be verified for every provider who administers services to patients. Depending on its size, a healthcare organization could be required to verify the employment histories and qualifications of hundreds or even thousands of physicians. This includes each practitioner’s education, medical training, residency, licenses, as well as any certifications issued by a board in the physician’s area of specialty.

Properly credentialing every single individual is an enormous amount of work for a team to handle. Hospitals or health systems may not allocate adequate resources or staff to complete the medical credentialing process, resulting in lost revenue and stressed, overworked staff who are more likely to make mistakes.

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