Self-Credentialing and Contracting Pitfalls to Avoid to Help your Practice Grow

Best practices for ensuring successful credentialing and contracting include:

Involving healthcare professionals throughout the process by providing instruction on the selection of action words and phrases, the process for credentialing, and the importance of the documentation. If a provider is not familiar with the documentation requirements, then he or she may be less likely to document appropriately and will more likely be denied by the patient’s health plan.

Identify the range of credentials or certifications currently in use across your clinic/hospital. While this may be obvious, knowing the “whose credentials” prevent future credentialing problems.

Determining who currently handles the credentialing process. This can be the person responsible for hiring or managing a staff person.

Ensuring current or past credentials are up to date.

Developing an integrated and efficient credentialing, contracting, and contracting for services process with the provider or supplier for specific services

Finding ways to streamline this process in order to reduce time and costs

Consistently enforcing the necessary documentation and documentation procedures, which should be well-documented, up-to-date, and consistent

Ensuring that the process and documentation support the success of the company’s mission

• Take the time to look at self-credentialing from a business perspective.
• Build in a contingency plan for credentialing and contracting.
• Use the same due diligence process for self-credentialing and contracting.
• Make sure the process is designed to be actionable and measurable.
• Make the process easy and efficient to follow.
• Set up a system to capture the data.
• Make sure the process is appropriate to the client.

Keep Exploring The Current Best Practices in the Industry

Successful credentialing and contracting practices always start with skills assessments and workforce needs analyses. This is an important part of strategic planning for practices looking to expand their bandwidth, establishment or industry. It is a critical first step in understanding the needs to be met in the industry and appropriation to be developed and deployed.