Properly credentialing physicians can increase ASC profits, according to Ted Gottis, senior vice president at MedTrainer. Mr. Gottis works with ASCs to help staff manage the credentialing process and the verification of new physicians' professional backgrounds when they join ASCs or hospitals.
Note: Responses have been lightly edited for style and clarity.
Question: Why do so many ASCs tend to struggle with properly credentialing their physicians?
Ted Gottis: The credentialing process is complex by its very nature. It is complex because there are many parts to the process, and for credentialing to be done correctly, it must be completed thoroughly and consistently for each provider in the ASC setting.
Credentialing is multifaceted and designed to protect patients, augment revenue cycle management and provide protection to an ASC in the event of litigation. An efficient and effective credentialing program maintains the proper focus on these three topical areas.
However, credentialing programs are frequently developed as a reactionary measure to mandatory ASC credentialing requirements. Doing the bare minimum will not provide the level of protection an ASC needs.
Q: How can having a smooth credentialing process lead to higher profits at an ASC?
TG: Proper credentialing can lead to greater profitability through the three areas: higher quality patient care, enhanced revenue cycle management and defense against litigation.
Addressing patient care issues, the inability to preserve cash flow due to inadequate credentialing and the cost of defending against litigation — both in terms of legal costs and hours lost to the defense effort — quickly absorb both time and financial resources, which erode an ASC's profit base.
Credentialing correctly and consistently from the outset can facilitate quality patient care through the admission of only qualified physicians to the ASC, enhance revenue cycle management by allowing the ASC to seek reimbursement without delays, and provide invaluable defense in litigation scenarios by providing demonstrative evidence of due diligence through a quality credentialing program.
Q: How can ASCs improve the credentialing process?
TG: ASCs can improve their credentialing process by taking advantage of technology that allows for providers to be credentialed faster, more effectively and with automated reminders for items that will expire in the future. Excel used to be the standard in credentialing, but due to the increasingly complex requirements of accreditation bodies and networks, a more advanced solution is now required.
It is no longer sufficient to rely on the memory of credentialing staff or spreadsheets and emails to track all that is necessary to accomplish in the establishment and ongoing management of a credentialing program. A credentialing solution allows the credentialing specialist to perform most — if not all — the necessary functions within the system. Systems that constantly require the user to leave the program to gather credentialing data slow down the process and jeopardize the consistency of the process. An ASC should seek out a credentialing management system that leverages the personnel resources available through technology and thereby increases the efficiency and quality of credentialing.