Credentialing Under Construction

A contractor is building several new homes in my community. I have been watching the excavation and grading of the property, the concrete basements being poured and the walls going up. All of these steps are necessary to achieve a good solid foundation on which to build the home. Many of us may never see this part of the process; only seeing the end product that is well designed and constructed with all the finishing touches.

A credentialing program can take on this same process. It doesn’t happen overnight and takes careful and thoughtful planning, development and implementation to achieve successful construction. The bylaws, policies and procedures, privilege forms, and monitoring processes are all building blocks required to pass inspection by The Joint Commission, CMS, HFAP or other accrediting and regulatory bodies. Credentialing is found in different homes, such as hospitals, CVOs, ASCs, medical groups, and health plans. Skilled tradesmen/women are critical to provide their expertise and experience to develop a sound process. Tools such as credentialing software allow the process to be well documented and tracked and offer many state-of-the-art features to be efficient, automated and paperless.

It’s a new year and a great opportunity to take a critical look at your credentialing and privileging processes. Has it kept up with the times or does it need some refurbishing? Maybe a few areas need to be remodeled, such as updating old privilege forms to criteria-based core privileges or sprucing up FPPE and OPPE processes. Or perhaps you need to build an NCQA-compliant process to support delegation agreements with payers for a medical group. Maybe your health system is considering a complete overhaul to centralize credentialing verification processes and integrate with recruitment and provider enrollment.

Whether you are looking at new construction or a rehab, your credentialing project will need a thorough assessment or appraisal, a detailed blue print of the desired product and a general contractor to oversee the project and ensure its completion. And make sure you do a final walk through before closing to identify any items that may need to be tweaked or fixed to assure the highest level of quality.

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