The benefits of becoming a delegated entity

As the healthcare environment evolves, the functions of the medical staff services department (MSSD) change to meet the needs of the hospital and its medical staff. Currently, many MSPs find themselves restructuring their credentialing process or the MSSD in order to become a delegated credentialing entity for managed care.

Delegated credentialing speeds up turnaround time by removing the health plan credentialing step of the process.

“Delegation eliminates the period of time that commercial payers would typically need to complete their own credentialing process, which could be 30, 60, 90 days or more beyond the hospital’s credentialing process,” explains Sally Pelletier, CPMSM, CPCS, chief credentialing officer with The Greeley Company.

The date that the governing board approves the physician most often becomes the physician’s effective date with the health plan. The physician can start seeing patients and billing for services within a few weeks, says Rachelle L. Silva, BS, CPMSM, CPCS, credentialing specialist with MultiPlan, a national PPO network .

Additionally, depending on the volume of practitioners and payers, the level of automation, and the delegated activities agreed to, the MSSDs may view delegation and the associated audits from the health plans as less onerous than the process of provider enrollment, Pelletier says.

Delegated status also benefits physicians, who now only have to fill out one application and work with one office (the MSSD) to accomplish both hospital credentialing and payer enrollment, Silva says.

Taking on managed care credentialing also has advantages for MSPs and the MSSD. A larger department and expanded scope of responsibilities often create opportunities for MSP career advancement, says Amy Niehaus, MBA, CPMSM, CPCS, president of AMN Consulting, LLC.