Understanding Credentialing and Enrollment Processes: Healthcare Organizations vs. Health Plans

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As someone who manages or oversees provider credentialing and payer enrollment for your hospital or healthcare organization, you understand the value of maintaining efficient processes across departments to save time, reduce costs and ensure providers are granted privileges as quickly as possible. Health plans (also known as managed care organizations) strive for similar goals. Understanding the payers’ specific accreditation and regulatory requirements can help you and your team of medical services professionals further ensure timely processing of provider applications. This white paper will explore: the processes payers conduct to evaluate and enroll healthcare providers; common challenges in provider enrollment and how to solve them; and tips and techniques to achieve delegated credentialing.

Credentialing Advancements in a New Delivery Era

Healthcare organizations continually seek opportunities to improve efficiency, eliminate redundancies, and increase quality to stay competitive in this ever-changing environment. During this one-hour, recorded webinar program, Credentialing Advancements in a New Delivery Era, Sally Pelletier, CPMSM, CPCS, Advisory Consultant and Chief Credentialing Officer for The Greeley Company, addresses strategies to achieve meaningful alignment and operational… [Read More]

CMS Termination Letters: What they mean and what to do if you get one (Infographic)

While it’s not something any hospital wants to acknowledge, the threat of receiving a CMS Statement of Deficiencies (CMS Form 2567) with Notice of Immediate Jeopardy or Notice of Termination is a reality. Hundreds of hospitals receive such notice every year. Because hospitals must be in compliance with all CoPs to continue participation in the Medicare… [Read More]

Delegated Credentialing in the Medical Staff Services Department

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There are several reasons why a commercial payer, such as a managed care organization or health plan, may consider delegating all or part of its credentialing activities to qualified business partners such as IPAs, PHOs, CVOs, medical societies, even other health plans. However, a growing trend observed by The Greeley Company is for hospitals and… [Read More]

The Greeley Company’s Credentialing & Privileging Compilation

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The Greeley Company has served administrative and clinical teams in more than 700 healthcare organizations nationwide within the past three years—including hundreds of credentialing and privileging-related projects. Our consultants also present at national and regional conferences and seminars throughout each year, serve as subject matter experts for various publications, and author dozens of resources including articles,… [Read More]

Phased Approach to Building Hospital-Physician Trust and Collaboration Achieves Positive Outcomes

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  A regional hospital with 350+ beds and a physician group practice of approximately 20 physicians plus allied health practitioners had tried to collaborate multiple times for more than ten years. Every failed attempt led to finger-pointing and broken trust on both sides—with each organization blaming the other for the failure to collaborate. The group… [Read More]

New Solutions for Physician-Hospital Integration

The imperative in healthcare today is to rapidly and significantly improve quality and reduce costs. While this goal is easy to articulate, it is incredibly challenging to execute—but the viability of your organization depends on it. We know you’ve squeezed supply costs. You’ve optimized revenue cycle. You’ve “leaned” everything you can. What’s left? The doctors…. [Read More]

Multifaceted Engagement Leads to Credentialing, Privileging, and Bylaws Improvements

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The Chief Executive Officer/General Counsel and Credentials Chair of a 25-bed, physician-owned surgical hospital in the Midwest both attended one of The Greeley Company’s national seminars, The Credentialing Solution, in San Diego in early 2015. They were impressed with the content of the seminar and followed up with The Greeley Company about conducting a gap… [Read More]

Customized Core Privileging Produces Compliant, Effective Privileging System

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During a July 2014 Joint Commission survey, one of CHRISTUS Santa Rosa Medical Center’s specialty hospitals experienced some specific compliance challenges related to their core privileging forms. Recognizing that the entire system was at risk of a repeat of these findings across all of their sights—and aware of Greeley’s national expertise in the area of… [Read More]

Outsourcing As A Solution to Your Credentialing Woes

Historically, the medical staff services department (MSSD) has operated behind the scenes in healthcare organizations, with few hospital workers outside the department fully understanding the extent of its responsibilities. However, the MSSD is truly the nucleus of the hospital, as it is responsible for everything from credentialing and privileging practitioners and meeting pertinent accreditation requirements… [Read More]