Common credentialing mistakes and how to avoid them

While it is human to err, there are some mistakes in the credentialing process that can easily be avoided. Leslie Cox, BS, MHA, CPMSM, CPCS, former senior director at Banner Health’s credentialing verification office in Phoenix, describes four common errors that can result when the credentialing process is completed improperly, along with strategies for overcoming them.

Mistake #1: Assuming all staff are competent in the credentialing process without providing site-specific training. Cox emphasizes the importance of providing all new staff members with appropriate training and education on the organization’s credentialing and primary source verification processes. One easy way to ensure new staff members adequately learn and follow processes, Cox suggests, is to “pair a new MSP with a seasoned MSP for the first few applications, and to encourage the new person to always ask questions when in doubt.”

Mistake #2: Assuming that quantity is a positive sign. Multiple employers or privileges at a variety of hospitals could be a sign of experience, or it could be a major red flag. Cox states that MSPs should be familiar with common red flags so they can easily identify them when reviewing an application and/or primary source verification documents. Having the ability to readily spot a red flag on an application is a key skill because it helps MSPs identify when hypervigilance is warranted. One way to make this easier for MSPs is to provide a list of items that could appear as a red flag on an application, Cox suggests.

Mistake #3: Rushing through the process because of pressure to complete the credentialing ASAP. To this, Cox says simply, “Never rush a file because someone is adding pressure. Be bold and do your job. Bring the matter to your supervisor if necessary, but never shortcut a careful review to rush a file. Allow time to carefully analyze the application and the verified documents.” If one does not dedicate time to this careful analysis, it can be easy to miss red flags such as peer references that rate the applicant’s performance as only “fair,” Cox states.

Mistake #4: Assuming that medical staff leaders, whether new appointees or seasoned veterans, do not need training regarding credentialing, their role in the process, and the consequences of negligence. It is important that medical staff leaders understand the purpose of the credentialing process and what could happen if they do not strictly adhere to it. Cox recommends providing this information through an orientation for new leaders and through intermittent refresher sessions for experienced ones.