4 Challenges That Make Physician Credentialing A Tough Task

10th, Feb 2023

4 Challenges That Make Physician Credentialing A Tough Task
Physician Credentialing is an undeviating pillar upon which a healthcare facility’s accountability and overall reputation balances. However, many roadblocks litter the path that leads to successful and timely credentialing. In this article, we present four such credentialing-related challenges that make life difficult for management teams at hospitals and practices all over the country. 
If there is one administrative task that requires painstaking precision and meticulousness in a healthcare setup, it is physician credentialing. A process that is exacting and directly effects reimbursements, credentialing is an absolute nightmare for those facilities where the administrative staff is not experienced or qualified enough to conduct the background work with the accuracy demanded by this process. A physician’s credential verification can take anywhere between 90 to 120 days, during which time the physician cannot be enrolled with any health plan. As a result, for any medical consultation or service performed by the physician in question during this period, the hospital or practice does not get reimbursed. The claims are either written off or put on hold! This can cause a pretty big dent in the facility’s overall revenues. The financial implications associated with delayed credentialing may make you believe that this process is bound to be the most airtight of the lot. Unfortunately, though, the reality is quite to the contrary. The challenges that shroud the credentialing process are many, and consequently, most healthcare units struggle to get their physicians credentialed on time and without too much fuss. 
Here are the top 4 problems that make credentialing such a monster:
  1. Numerous Legalities To Take Into Account – Requirements of the credentialing process vary from one accrediting entity to another and also from state to state. Keeping track of exactly what needs to be collected and submitted and in what format can be baffling, to say the very least. It is an excellent idea to enlist the services of a third-party vendor that can handle all your credentialing activities for you. 
  2. Acquiring Peer References Can Be Next To Impossible – Peer references are an integral part of the credentialing process. These vital pieces of documentation are quite difficult to attain owing to the packed schedules of practicing physicians whose references you are seeking. Ensuring that you have completed all the requirements before approaching the peer physicians so that they are not bogged down by any additional administrative work other than just writing the review, is an excellent way to avoid disgruntling them and getting your job done quickly. 
  3. Documenting Lengthy Professional Histories Can Be Tedious – Tracking a senior physician’s history as part of the credentialing process can be quite cumbersome. Some offices where such physicians have worked in the past have long since been closed, adding to the complexity of the verification process. 
  4. Maintaining Recency – Mandatory re-evaluation every few years, as per the laws of the state, makes credentialing a cyclical process that needs to be revisited periodically. As a result, it is necessary to maintain records for all the checks conducted in the prior years to facilitate future verifications. 
Mirra Health Care (TPA), an organization that employs professionals with years of experience in the field of credentialing, can be a valuable asset to any hospital or practice. Specialists at Mirra can act as consultants and provide insights on how you can organize and train your administrative staff to handle physician verification better. They can also take over your entire credentialing process and manage it on their own so that you do not have to fret over it ever again. Either way, you stand to gain a lot from having a partner like Mirra by your side.

For more information on how you can partner with Mirra and utilize the services in their Medicare in a Box solution, get in touch with us -

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