In most industries, the process of hiring and onboarding a new employee is generally straightforward. A typical process includes several manual steps of resume reviews, screening, interviews, and onboarding. And even if the individual fails to perform as expected or makes a mistake on the job, it likely will not result in physical harm or a lawsuit.
But in healthcare, appointing providers to a healthcare organization goes beyond finding the “right culture fit.” The process is much more complex, and rightfully so, as people’s lives are literally in their hands.
The Centers for Medicare & Medicaid Services (CMS) and the Joint Commission on Accreditation of Healthcare Organizations both require provider credentialing, the process by which medical organizations verify the credentials of providers to ensure they have the required licenses, certifications, and skills to properly care for patients. Credentialing guarantees that a provider is certified to deliver safe, high-quality healthcare.
Verify and Validate
The most crucial step of provider credentialing is primary source verification (PSV). PSV is similar to a background check, but more inclusive and time-consuming. It requires a healthcare organization to communicate directly with an originating source to validate the accuracy of a provider’s educational degrees, licenses, credentials, references, or other pieces of information that may impact performance.
There are various methods for conducting PSV, including direct correspondence, documented telephone verification, secure electronic verification from the original qualification source, or reports from credentials verification organizations (CVOs) that meet Joint Commission requirements.
Though many aspects of PSV are digitized, much of the process is still manual, requiring staff time to individually contact organizations, search databases, and cross-check records. Meanwhile, new clinicians cannot bill payers for services until all credentials have been verified.
In short, PSV requires a lot of tedious, manually ridden detective work that’s problematic at best.
Why PSV is More Critical Than Ever
Healthcare organizations aim to hire and retain providers that help the organization’s reputation through delivering exceptional care, receiving high patient satisfaction scores, and avoiding legal issues such as malpractice. Organization leaders can sleep peacefully at night knowing that their employed providers have gone through a PSV process; what keeps them up at night might be, just how sound is our PSV process?
As technology moves business and society forward, it also comes with downfalls. In this situation, technology can make it easier for individuals to forge their credentials and qualifications, including educational backgrounds and professional licenses. This is a main reason that PSV is so crucial, and where automation can step in to detect these fraudulences at the front end. Additionally, PSV ensures providers keep accurate and up-to-date credentials to maintain good standing within provider and payer networks on the back end. Transitioning these tasks from manual to automated not only removes wasted time and human error from the equation, but PSV also enables organizations to be more audit ready and efficient for adhering to NCQA compliance.
Staying Current is Key
Due to a global pandemic, we have been reminded how critical it is for capable providers to be at the forefront of patient care. Especially in today’s environment, healthcare organizations are feeling the pressure to adopt an all-hands-on-deck approach. In times like these, it is unacceptable for the PSV step of credentialing to be a months-long process. With so many of these verifications relying on manual processes, that is the harsh reality.
Furthermore, provider credentialing is not just a one-and-done process. It is absolutely critical to verify providers initially, but it is just as important for providers to maintain all of their credentials and stay current. To prove this, providers are recredentialed every two to three years.
Recredentialing, often referred to as renewing insurance panels, closely mirrors the initial credentialing process. Recredentialing is a payer activity that entails reviewing and potentially requesting renewal of professional credentials to maintain status with a health network. If a provider does not complete the recredentialing process they may not be eligible to continue participating in payers’ networks.
Automation Makes PSV More Seamless
While PSV is a time-consuming process, it is absolutely essential. The most effective and efficient way to perform primary source verification is to automate it. At Madaket, we offer automated PSV through our partnership with andros.
Credentialing is a known to be notoriously slow process made more disorganized by human error. By partnering with andros, the Madaket platform now has automated PSV, enabling providers to obtain the information they need from original sources faster, cut down on the often months-long credentialing process, and get new clinicians practicing and billing sooner.
Our collaboration with andros is the just the latest partnership of what we believe will be many in our endeavor to build trust across all facets of healthcare, one relationship at a time.