News

by Jamie Amedee.

Expanding your practice often requires hiring additional medical staff. Although the added patient volume is welcome, it can also be overwhelming when trying to on-board a new physician or nurse provider. Regardless of their specialty or expertise there is a lot to do before they begin taking care of patients. Many of the ‘to do’ items are under the credentialing umbrella.

Credentialing can mean many things. But, in the context of on-boarding a provider to your team, it means making sure that they are licensed, competent, privileged to work at your facilities and will get paid by your insurance payors on their first day of work. As you can imagine, this means a lot of paperwork.

Orchestrating the completion of this paperwork with your target start date in mind is the tricky part. It takes planning and coordination between your administrative staff or provider services department, the billing company, clinical facility medical staff offices, credentialing verification offices and your newly hired provider. These are your key contacts during the on-boarding process and play an important part in ensuring an on-time start date. So, where do you begin?

Begin with your target start date. This date needs to be considered carefully as a part of your contractual employment agreement for successfully on-boarding your newly hired medical staff. Realistically, you need to begin your paperwork 4 months prior to your determined clinical start date to ensure that all privileges and payor contracts will be in place on time. This timeframe is for your best case scenario. If the provider is not licensed in your state, is not responsive to your requests for documents, has adverse issues or incidents, has past or pending malpractice claims or an extensive work history then plan on the process being extended as much as 2 months or more.

Your first month should be spent gathering a complete credentialing file from your new provider. This file will include the items listed here and possibly more depending on the specialty:

• Licensure in the primary practice state
• Licensure ever held (expired and current)
• DEAs and State Controlled Substance Registrations
• Board Certifications
• Malpractice Liability Insurance Certificates
• Malpractice Claims History
• Immunization Records
• Diplomas (undergraduate, graduate, medical, internship, residency, fellowship)
• Certification Cards (BLS, ACLS, PALS, ATLS, etc.)
• Continuing Medical Education Certificates
• Military Service documents
• Foreign Medical Graduate paperwork
• Curriculum Vitae or Resume
• Identifying Documentation
• National Provider Identifier
• Professional References
• Competency Documentation

As the provider gathers their documents and forwards them to you, do your homework by getting to know them through their C.V. Look up the contact information for their education and training. Complete online licensure searches and examine the government exclusion lists to ensure they are eligible to be added to insurance provider rosters. The time invested in getting to know your provider will save you time later on in the process. You will be able to anticipate questions that will eventually be asked of them and find the answers prior to submitting paperwork on their behalf.

It is imperative that you have a complete file prior to starting any applications or enrollments for the provider so that you do not waste valuable time later responding to missing items letters from your intended recipients.

Next, communicate with your key contacts. Here are some questions that you may want to ask:

• What facilities will the provider work at?
• Which insurance contracts will they be added to?
• Do they need membership to the local IPA?
• Do they need membership in the local or state professional organization?
• What malpractice policy will cover their work?
• Are they eligible to be a Medicare and Medicaid provider?
• Who will be arranging their orientation at hospitals, surgery centers or clinics?
• What training do they need to attend in order to successfully join the medical staff?

Once these questions are answered, gather the applicable applications and enrollment forms. Understanding the filing requirements of each form is essential to success. What is the submittal and processing time for each? What supporting documentation needs to be included? If you know the answer to these questions then you will be able to organize and date each item so that they are completed, signed and submitted on time and without issue. Work closely with your key contacts and your provider so that there are updates on the progress and status of each process. These updates will help you avoid any surprises and allow you to address issues in a timely manner.

Although on-boarding a new member of your medial staff can be daunting, it is possible to have a smooth process and timely start date with the proper knowledge of their professional life and good communication between your key contacts. With careful planning and coordination you will have a competent, privileged and paid physician or nurse on staff to help with your growing practice.

Jamie Amedee is EMP’s Director of Medical Staff Credentialing