While electronic health records have been widely recognized and implemented throughout hospitals, electronic credentialing receives little attention, although it can also drive efficiencies and savings — potentially millions — in hospitals.
Savings
Matt Haddad, president and CEO of the provider data management company Medversant, says electronic credentialing systems can save hospitals time and money by creating a single digital file that can be shared between institutions. While in the past staff would have to spend time retrieving paper files, an electronic database allows hospitals to quickly and easily access providers' information. "A lot of staffing is necessary to support a credentialing operation. If you can come up with a more streamlined approach, then you won't need as much staff in this area and they can be redeployed where [they are] more necessary," says Mr. Haddad.
Electronic credentialing also creates efficiency by eliminating the need for hospitals to collect paper files every year. Instead, credentialing information is entered only once and then updated when necessary. Furthermore, electronic credentialing can automatically verify information using the Internet, saving hospitals time and resources. Mr. Haddad estimates that credentialing manually costs $500 per provider, whereas an electronic process can cost $75-100 per provider.
In addition to improved efficiencies and reduced costs, electronic credentialing could also limit human error in recording credentials information. Accuracy in credentialing can potentially save hospitals a significant amount of money in administrative costs and potentially by avoiding recovery audits issues. "Poorly run credentialing [can cost] multiple millions of dollars in recovery audits," Mr. Haddad says. For instance, a claim can be rejected if a provider submits the claim during a period of lapsed licensure. Proper credentialing can help ensure that providers' credentials support claims made under the Medicare or Medicaid program. Mr. Haddad explains that fraud is "low hanging fruit" for the Centers for Medicare and Medicaid Services as it attempts to eliminate fraud waste and abuse. "Without electronic credentialing, hospitals are vulnerable to recovery audit liability," he says.
Implementation
One way to implement an electronic credentialing system is to integrate it with electronic health records. In this model, digital records of a patient would include information about his or her provider. Like most changes, however, electronic credentialing will not produce immediate benefits. Mr. Haddad says, "If the hospital has for years been reliant on manual processes, simply turning on a new electronic credentialing platform [will] not change things overnight. Change management is involved. Hospital leaders need to assist in making this change happen."
Medversant is already working with two states to establish a state-wide electronic credentialing platform. Through a Medicaid transformation grant, Medversant has set up an electronic credentialing database for Michigan and became Michigan's licensing system for gathering credentials. Medversant is also working with Washington state to implement a centralized credentialing database. Mr. Haddad predicts that in the future there will be a more regionalized approach to credentialing, similar to the systems in Michigan and Washington state.
"The age of each hospital individually verifying the background of doctors or gathering that information is an antiquated concept. In order to accomplish the goals of healthcare reform, electronic healthcare credentialing is a must," Mr. Haddad says.
Learn more about Medversant.
Savings
Matt Haddad, president and CEO of the provider data management company Medversant, says electronic credentialing systems can save hospitals time and money by creating a single digital file that can be shared between institutions. While in the past staff would have to spend time retrieving paper files, an electronic database allows hospitals to quickly and easily access providers' information. "A lot of staffing is necessary to support a credentialing operation. If you can come up with a more streamlined approach, then you won't need as much staff in this area and they can be redeployed where [they are] more necessary," says Mr. Haddad.
Electronic credentialing also creates efficiency by eliminating the need for hospitals to collect paper files every year. Instead, credentialing information is entered only once and then updated when necessary. Furthermore, electronic credentialing can automatically verify information using the Internet, saving hospitals time and resources. Mr. Haddad estimates that credentialing manually costs $500 per provider, whereas an electronic process can cost $75-100 per provider.
In addition to improved efficiencies and reduced costs, electronic credentialing could also limit human error in recording credentials information. Accuracy in credentialing can potentially save hospitals a significant amount of money in administrative costs and potentially by avoiding recovery audits issues. "Poorly run credentialing [can cost] multiple millions of dollars in recovery audits," Mr. Haddad says. For instance, a claim can be rejected if a provider submits the claim during a period of lapsed licensure. Proper credentialing can help ensure that providers' credentials support claims made under the Medicare or Medicaid program. Mr. Haddad explains that fraud is "low hanging fruit" for the Centers for Medicare and Medicaid Services as it attempts to eliminate fraud waste and abuse. "Without electronic credentialing, hospitals are vulnerable to recovery audit liability," he says.
Implementation
One way to implement an electronic credentialing system is to integrate it with electronic health records. In this model, digital records of a patient would include information about his or her provider. Like most changes, however, electronic credentialing will not produce immediate benefits. Mr. Haddad says, "If the hospital has for years been reliant on manual processes, simply turning on a new electronic credentialing platform [will] not change things overnight. Change management is involved. Hospital leaders need to assist in making this change happen."
Medversant is already working with two states to establish a state-wide electronic credentialing platform. Through a Medicaid transformation grant, Medversant has set up an electronic credentialing database for Michigan and became Michigan's licensing system for gathering credentials. Medversant is also working with Washington state to implement a centralized credentialing database. Mr. Haddad predicts that in the future there will be a more regionalized approach to credentialing, similar to the systems in Michigan and Washington state.
"The age of each hospital individually verifying the background of doctors or gathering that information is an antiquated concept. In order to accomplish the goals of healthcare reform, electronic healthcare credentialing is a must," Mr. Haddad says.
Learn more about Medversant.