Keeping on top of credentialing renewals and re-attestations is not optional. Let one lapse and you’ll find yourself facing billing disruptions, denials, and unhappy providers. So, how can a practice avoid stumbling over this recurring hurdle? By building a robust system to track and complete these tasks long before they become issues. Here’s how.
Know the Timelines
Credentialing renewals aren’t uniform across the board. Each payer, and sometimes even specific plans within a payer, has different timelines. Some require renewals every year, while others might stretch to two or three years. Medicare revalidations, for example, typically occur every five years but can vary. The best way to stay ahead? Create a master schedule that lists each provider, their payers, and specific due dates. This way, no one gets blindsided by a surprise deadline.
Centralize All Documentation
One of the biggest pitfalls is having credentialing documents scattered across different platforms and folders. Centralize everything. Use a shared drive or credentialing software where all contracts, applications, and communication history are accessible. This centralized repository should be updated every time there’s new correspondence or documentation. It’s also a good idea to have a checklist for each provider that includes what has been completed and what is still pending.
Automate Alerts and Reminders
Manual reminders are a recipe for disaster. Set up automated alerts and reminders at least 90 days before renewal deadlines. This gives plenty of time to gather necessary documentation and complete the process — because let’s be honest, some payers’ portals are still as user-friendly as a tax form. Use your practice management software or a dedicated credentialing tool to create these alerts. Redundant, you think? Not at all. This redundancy can be the difference between staying credentialed and scrambling to fix a lapse.
Prepare for Payer Quirks
Every payer seems to have its own set of quirks. Some are notorious for losing documentation, while others might take weeks to process a simple update. Expect delays and unpredictability. If Blue Cross Blue Shield takes forever with your renewals, start even earlier. Note these quirks in your central repository so that any team member handling credentialing knows what to anticipate.
Regularly Audit Your Process
Credentialing isn’t a set-and-forget task. Regular audits are essential. Every quarter, review upcoming renewals, check the status of ongoing applications, and evaluate your documentation process. Are your alerts functioning correctly? Is there a pattern in delayed renewals with certain payers? Regular audits will keep your system in peak condition and prevent last-minute scrambles.
Train Staff Thoroughly
Credentialing can be complex. Ensure that your staff handling this critical task is well-trained. They should understand the nuances of different payers, know how to navigate payer portals efficiently, and be clear on the paperwork required. Consider periodic training refreshers for your staff to stay updated on any changes in payer requirements or processes.
Communicate with Providers
Providers need to be in the loop. They should be informed well in advance of any upcoming requirements for re-attestation or credentialing renewal. Their involvement is often necessary to update personal or practice information. Clear communication can prevent snags in the credentialing process that might otherwise delay renewals.
Manage Changes Promptly
Any changes in a provider's information — address, tax ID, ownership details — require immediate attention. Payers need updates for accurate records, and any delay can lead to issues with credentialing status. Develop a protocol for promptly handling these changes. Assign a dedicated team member to oversee these updates so nothing slips through the cracks.
Use Credentialing Software
If your practice is managing multiple providers across different locations, credentialing software can be invaluable. These tools can automate much of the tracking, alerting, and documentation process. They can also help with analytics, providing insights into the efficiency of your credentialing operations.
Plan for the Worst-Case Scenario
Despite best efforts, lapses can happen. Prepare for these scenarios. Have a plan in place for handling credentialing gaps. Can certain providers pick up additional shifts to cover the gap? Will locum tenens be necessary? Having a contingency plan allows your practice to react swiftly without a significant disruption to patient care or revenue.
Credentialing renewals and re-attestations might feel like an administrative chore, but they are integral to a practice’s financial health. By building a solid system to manage these tasks, a practice can avoid costly disruptions and ensure steady revenue flow. Addressing this proactively is not just smart; it’s necessary.
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