Headache relief: outsourcing credentialing for a busy physician practice brings improvement. (What works: credentialing).

For many physicians, the words "credentialing" and "headache" are synonymous. But headaches can be fixed with Tylenol. Credentialing is not so easy.

The concept and complexity of credentialing has expanded greatly in recent years as the number of payers and government agencies has grown. Many years ago, physicians underwent credentialing primarily to qualify for membership on a hospital staff. They did this by presenting to the institution proof of their medical school education, specialty certification and state medical license.

Today, many physicians admit to five to 11 hospitals, submit claims to a dozen or more managed care organizations, and are licensed or regulated by multiple state and government agencies. Each agency has its own deadline and its own application requirements--some of the forms run 15 to 20 pages. In many cases, the same questions are asked, but in a different order or format.

It all adds up to a logistical nightmare for physician practices. One study reported earlier this year in the AMA News estimated that handling all the various forms of credentialing costs physician offices more than $1 billion a year in administrative costs. That's a costly headache.

PROBLEM

Texas Retina Associates, based in Dallas, TX, has 10 ophthalmologists in nine locations across northern and western Texas. Our practice specializes in the management of disorders of the retina and vitreous body of the eye. Our highly trained surgeons use advanced, complex equipment such as argon lasers for photocoagulation. The practice has grown steadily in recent years, and we now average 300 patients per clinic day.

In recent years, we have added physicians and practice locations. Our credentialing needs were not just adding up, they were multiplying by leaps and bounds, since some organizations require separate credentials for each physician at each location. In addition, one of our new offices was in Lubbock, about 350 miles west of Dallas. This created additional logistical burdens on office staff.

Each of our physicians is credentialed by several hospitals, a dozen or more health plans, and numerous state and federal agencies. Altogether, we were processing more than 300 credential renewals and applications annually. Since each application requires at least one or two hours to complete manually, this task was consuming around 30 to 40 staff hours per month.

At best, credential processing is labor-intensive and tedious. Since staff is often forced to postpone this chore to when patients are not in the office, it becomes even more unwelcome. This can increase the rate of mistakes and incomplete paperwork on manually processed forms.

SOLUTION

In mid-2001, we decided to look for help with credentialing. After reviewing several options, we decided to seek the help of MedSynergies Inc., a business services provider that was already handling many of our administrative and financial functions. MedSynergies selects leading practice management, automated claims processing and financial analysis software, and provides them to practices on an ASP basis. MedSynergies' new service, CredentialsRx, automates the credentialing function by combining document scanning, data warehousing and scheduling with an advanced SQL database.

Since we were already receiving a suite of practice management software and services from MedSynergies through a broadband connection on a fee basis, the CredentialsRx program was added seamlessly to our current system. Our staff met frequently with MedSynergies consultants as we went over the credentialing requirements of each physician. We reviewed each physician's medical education and licensing records, and the key documents were scanned and stored as digital images.

CredentialsRx now sends our physicians and office staff regular alerts of any upcoming licenses or certifications at set parameters (e.g., 30 or 60 days prior to expiration). When we receive a new application or form, we send it to our MedSynergies representative, who scans and stores it. CredentialsRx can access a database of more than 6,000 ready-to-use forms from virtually every payer organization and government agency. Each physician's source documents, such as medical licenses and DEA certificates, also are digitized and stored. Using the software's data-mapping technologies, our MedSynergies representative completes every application according to the credentialing entity's requirements. This is not a blanket or "one size fits all" form. Instead, every application is produced in a complete, letter-quality form. If appropriate, it is produced on the credentialing entity's actual form.

The finished application, completed accurately with backup documentation, is delivered to us with a mailing envelope. We obtain the physician's signature and put the signed form in the mail. Although there is a growing acceptance of electronic signatures in other fields, at this point, virtually every healthcare organization with credentialing forms requires a hard copy with a pen-and-ink signature from the individual physician.

RESULTS

Since outsourcing the credentialing function, the burden on Texas Retina staff has eased substantially. Prior to our decision, we were considering hiring additional staff to help with credentialing. Instead, with CredentialsRx, we have been able to maintain current staffing levels and improve overall job satisfaction by eliminating a complex, time-consuming chore.

The accuracy of completed applications has improved considerably. Our payers are glad to receive complete and precise information every time. Also, our physicians are relieved to be given neat, accurate forms to sign with plenty of time to spare. Their individual curriculum vitae are updated automatically as CredentialsRx adds new data, and we can obtain reports listing the current status of payer and health plan affiliation by physician, which is useful in managing the practice's workflow. Additionally, the provider database can be accessed by our staff via an easy-to-use interface for other uses, such as billing and claims processing. The information is compliant with NCQA and JCAHO standards.

New credentialing, licensing and hospital privilege applications are even more complex and daunting than renewals. The storage and search capabilities of CredentialsRx greatly sped up completion of the original applications and set the stage for a smooth recredentialing in coming years.

For more information about CredentialsRx from MedSynergies, www.rsleads.com/302ht-211 or Circle 211

SOURCE

Jefferey T. Brockette
Administrator/CEO
Texas Retina Associates
Dallas, TX
www.texasretina.com

PRODUCT/COMPANY

CredentialsRx
MedSynergies Inc.
Irving, TX
www.medsynergies.com