The credentialing profession is about consistency. Regulatory and accrediting agencies mandate a set of criteria; all we have to do is follow each criterion to the letter. Does that sound simple to you? To the individual unfamiliar with those simplified criteria, yes. The first impression would be to follow the directions to create a successful program. However, those of us in the profession know that the process is anything but simple. So, how do we meet those criteria?
Collecting and verifying data may be the easy part. What you do with that data is a complicated piece. That defines the credentialing process, which is doing what needs to be done with that wonderful data. Every healthcare organization that hires or contracts with a healthcare provider is tasked with more than just collecting data on or from these individuals. It is the organization's responsibility not only to keep track of that data but to analyze it, approve it, re-assess it periodically, monitor it, and improve upon the processes continuously. That is why it is essential to have a seasoned professional or a professional dedicated to learning the nuances of credentialing, leading the charge to establish and maintain a consistent and compliant program.
What is a consistent program, one that operates nearly flawlessly? Based on consistency, the program has a well-defined structure, a trained staff, and a database that supports staff productivity. Think about what consistency means. The word is defined as conformity in the application of something or that which is typically necessary for the sake of logic, accuracy, or fairness. Doesn't that describe credentialing? Its logic is to ensure that providers are competent and qualified to deliver healthcare services. Accuracy is key in the credentialing process, getting the right data, the first go-around, documented accurately and in a manner that treats all providers fairly and equitably. Maintaining a consistent credentialing program is critical to keeping your organization alive. You are responsible for ensuring it provides the services it promises from the clinical providers you have credentialed. For an effective credentialing program, don't fail to practice consistency.
But what about the habit of doing it right? What's your game plan? Do you rely on schedules, routines, and checklists only? How does staff operate? Are they all on the same page? That's stepping out of the box when it comes to individual performance. One person may closely review an application upon receipt to determine its completeness. Another person may begin processing it line by line and then discover something is missing or requires an explanation. Which one is right? When training your staff or onboarding someone with experience, have expectations been established, like timelines for obtaining a completed application? If you are wondering why I am bringing habit into the topic of credentialing, it's because a team member's habit can affect how the whole department operates. If someone has the habit of holding an application until the previously received applications are complete or have reached near completion, that may be a problem. Putting an application on hold could delay the completion process in a sufficient timeframe. Problems can occur if expiration dates are checked post-expiration by only checking for renewals on a specific date of the month, especially if you still need to follow up on those before their expiration dates.
Why are habits a concern? When dealing with that staff member during a performance review, the staff member's deficiency in processing files may not be because they don't know what they are doing or exhibit any other deficiency like timeliness; it could be because of their work habits. The order of their production may result in a deficiency. Training and onboarding should include how they perform the job and plan to meet expectations to help everyone develop like habits, and an operational manual to guide the staff in step-by-step expectations.
A couple of things may help your staff develop great habits: First, a book called Atomic Habits, Tiny Changes, Remarkable Results by James Clear, and secondly, a well-defined, documented set of operations.
If you need help documenting your operations with policies, standard operating procedures, credentialing tools, or operations manuals, contact me on LinkedIn or my website.
Dilsa S. Bailey, CPMSM is the owner and principal consultant for The Right Credentials Network and an independent publisher and author. If your organization's credentialing and provider enrollment programs need assistance, contact The Right Credentials Network. We can help you apply for and maintain accreditation, build your delegation arrangements and repair your existing credentialing program. And, if you or your staff needs additional training, let us create a package to fit your needs.
Comments