One of the most common things that can lead to increased liabilities in malpractice lawsuits is hiring an incompetent healthcare provider, as well as letting them continue to work with your practice. This makes it all the more important that enrollment and credentialing your providers is always managed as properly as possible, as well as kept up to date. If you fail to do so, then your revenue cycle will end up taking a major hit.
The best way to ensure that everything is properly managed is to first understand the difference between credentialing and enrollment.
For starters, credentialing is generally defined as verifying all of the training, education, and proven skills of a healthcare provider. This is done by contacting the source that has provided the training, education, and license of the provider. This process is used by facilities as a basic part of their overall hiring process, as well as by insurance companies in order to enable the provider to participate in their network.
Provider enrollment, on the other hand, involves the process of requesting participation as a provider in a health insurance network. Additionally, it also involves completing the credentialing process, submitting supporting documentation, and signing the contract.
If credentialing is done in an improper manner rather than a more proper one, this can end up leading to either delayed or even denied reimbursement for any services that may have been provided. Even worse is the fact that it can also result in more serious consequences in terms of statutory compliance violations. This can lead to serious monetary damages and even criminal charges.
Both of these processes have been generally overlooked for years, yet their overall impact on issues involving compliance and financial aspects for practices have ensured that they remain important components to any and all thriving practices.
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