If you are planning to hire a new doctor or establish your own practice, it is crucial to initiate the credentialing process ahead of time to prevent potential issues. Neglecting the importance of medical credentialing services could lead to delayed cash flow, challenges in scheduling due to patient restrictions, and frequent communication with insurance providers.
This article aims to list 10 effective tips for successful medical staff credentialing. Before getting into that topic, let us first understand the significance of credentialing.
Provider credentialing is the process of confirming a physician’s attendance at a medical school and their possession of a state license. It also entails verifying their employment history and examining malpractice insurance carriers that are associated with them.
Additionally, credentialing requires conducting a background check on the provider's criminal and financial records, as well as a review of their social media background, which is becoming increasingly important. The references provided by the physician will also be checked. Since this is a complex procedure that often takes longer than anticipated, it is crucial to start preparing early. Here are ten helpful tips to ensure a successful provider credentialing process.
1. Connect with a medical staff credentialing partner
If you intend to delegate credentialing responsibilities, it is important to engage with a medical credentialing service such as ProLocums to effectively manage deadlines and expiration dates. By receiving timely reminders, you can guarantee that no one's credentials lapse, preventing any denials of reimbursements.
2. Make sure to allocate sufficient time for the credentialing procedure
It is recommended to budget around 150 days for the credentialing process, although it is expected to take approximately 90 days. It is important to be aware that each payer has its own timeline for credentialing. By assuming a longer time frame, you can ensure that you are prepared for the process, and if it takes less time, it will be a pleasant surprise.
3. Keep informed about the credentialing program offered by the Coalition for Affordable Quality Healthcare (CAQH)
Payers are widely embracing the Coalition for Affordable Quality Healthcare (CAQH) uniform credentialing program. Physicians who consistently update and verify their information through CAQH experience smoother and more effective credentialing and re-credentialing processes, making it highly beneficial to engage with this program.
4. Link the start date of a new provider to the submission of their credentialing forms
Some practices require credentialing paperwork to be submitted immediately after extending an employment offer, while others tie the starting date of a new physician to the submission of paperwork. For instance, you could set the starting date no earlier than 120 days from the receipt of their credentialing information.
5. Develop a credentialing process that is sustainable
Establishing a credentialing workflow may pose difficulties, but it proves beneficial in the long run. Regardless of whether the credentialing process is outsourced, your workflow must ensure the retention of all necessary forms and documents. In a practice with multiple physicians, re-credentialing constantly arises, making it highly advantageous to have a workflow that can effectively handle this task.
6. Do not make the assumption that all payers permit billing a new physician as locum tenens.
You have the option to bill a new physician as locum tenens with certain payers if their credentials are not yet complete. However, not all payers allow this practice. It is advisable to complete the physician's credentialing process in order to bill normally. If that is not possible, it is recommended to contact the payers to determine their policy on locum tenens billing.
7. Ensure that you regularly update all contact information for physicians
Ensure that your credentialing coordinator keeps accurate and current contact information for all physicians. It is crucial to have direct contact in order to efficiently handle any credentialing or re-credentialing matters. Additionally, the credentialing process requires submitting multiple forms, and it is vital to maintain clear communication throughout.
8. Ensure that every physician has a clear understanding of the obligations and expectations placed upon them.
It is essential for every provider to be aware of their obligations regarding credentialing or re-credentialing. Upon extending a job offer, it is important to clearly communicate to the new employee the specific information required, such as their work and education history, certification and license details, as well as malpractice liability certification, among other necessary documents.
9. Perform a personal background check at the outset
Numerous practices opt to perform independent background checks on prospective physicians, ensuring their training, licensure, and employment records are accurate before extending a job offer. While it may seem excessive, this precautionary measure effectively prevents any potential complications stemming from licensing issues after hiring.
10. Gain a complete understanding of the regulations in your state
Physician credentialing laws may vary by state, and some states may have reciprocity agreements with payers and other credentialing organizations from different states. If a physician is already credentialed with a payer in another state and plans to join your practice, the payer may expedite the credentialing process for their new position.
Having a clear understanding of credentialing processes can greatly improve the efficiency of practice and accelerate cash flow. Issues with medical credentialing services can be costly and hinder productivity, highlighting the need for a well-established procedure to ensure credentials are always up to date. To ensure you experience a seamless credentialing process, connect with ProLocums.
In healthcare, locum tenens is a term derived from the Latin phrase meaning “placeholder.” It refers to professionals hired to temporarily step in for another provider during their absence due to reasons such as illness, vacation, maternity leave, or continuing medical education. These professionals, often called “locums,” fulfill the same duties as regular providers, ensuring continuity of care for patients. However, there are important distinctions between locum tenens providers and temporary staff, especially regarding medical credentialing services.
Understanding these differences is crucial for healthcare organizations, as each category of provider is subject to different federal guidelines and requirements.
The primary distinction between locum tenens providers and temporary staff lies in their duration of service requirements.
While these terms are often used interchangeably, they are not synonymous when it comes to compliance and reimbursement. Organizations must carefully distinguish between the two to avoid administrative complications or delays in payment.
A locum tenens provider has several defining characteristics that set them apart from regular temporary staff. These include:
1. Traveling Clinician Role
Locums often work with one or more agencies, taking temporary placements in various geographic locations as needed. They typically do not maintain their own independent practices.
2. Specific Circumstances for Engagement
Locum tenens professionals are hired due to specific, temporary unavailability of the regular provider, such as medical leave or professional sabbaticals. They are not used to cover routine staff shortages or regularly scheduled time off.
3. Patient Service Flexibility
Locums may provide services beyond the regular provider’s office, ensuring continuity of care for the patients of the absent clinician.
4. Service Period Restrictions
Medicare guidelines specify that locum tenens professionals cannot provide services for more than 60 consecutive days for the same absent provider.
The documentation requirements for locum tenens providers are stringent, making it essential for health systems to adhere closely to federal guidelines.
1. Independent Contractor Status
Locum tenens professionals are considered independent contractors, not employees. They are typically compensated on a fixed per-day basis by the regular provider or the agency placing them.
2. Documentation Requirements
The regular provider must:
3. Special Cases for Post-Operative Care
Substitution services during the post-operative global fee period should not be identified as locum tenens services on claims.
4. Group Practice Exceptions
In group practices, if a locum tenens provider replaces a departing physician, they may be considered part of the group until a permanent replacement is hired. This is allowed as long as the locum’s services to Medicare patients do not exceed the 60-day limit.
If the circumstances of the provider’s employment fall outside the scope of the locum tenens guidelines, the substitute is classified as temporary staff. In such cases, they must undergo the full credentialing process of the host organization, including background checks, licensure verification, and payer enrollment.
Locum tenens providers are a valuable solution for healthcare systems facing temporary provider shortages. They ensure that patients continue receiving uninterrupted care while allowing organizations flexibility to address staffing challenges. However, adhering to the appropriate credentialing guidelines is critical to:
Navigating the complex rules of locum tenens and temporary staffing can be challenging. ProLocums offers credentialing verification services to assist healthcare organizations in managing locum tenens providers efficiently. From credentialing to payer enrollment and licensure applications, ProLocums ensures compliance and helps organizations meet their temporary staffing needs seamlessly.
By understanding and applying the correct rules for locum tenens providers, healthcare systems can make the most of this flexible staffing option while maintaining compliance and delivering high-quality patient care. For more details, visit Prolocums.com.
12/11/2024
If you’re a physician looking for flexibility and additional income without the commitment of a full-time position, locum work could be the perfect solution for your off days. Locum allows doctors to fill in at facilities experiencing physician shortages, offering supplemental pay and the freedom to set their own schedules. In this blog, we’ll explore why many physicians are opting for locum physician jobs, how these roles help doctors manage their time and careers more effectively, and how you can take advantage of this growing trend.
For physicians looking to avoid the pressures and long-term commitments of full-time practice, a locum job provides an ideal way to maintain a flexible work-life balance. Let’s dive into some of the key reasons why locum work is becoming so popular for physicians.
One of the greatest advantages of locum work is the scheduling flexibility it offers. Physicians can take on locum jobs during their off days from their regular practice or between more permanent commitments. You can choose when and where to work, allowing you to craft a schedule that works around your lifestyle.
This flexibility is especially beneficial for doctors looking to reduce burnout or avoid the rigidity of a traditional practice. If you’ve been feeling overworked or drained, locum work offers a change of pace, giving you the ability to work as much or as little as you want.
If you find that your current position is causing burnout or just need a change of scenery, locum jobs allow you to travel. You can work in different locations across the country, or even internationally, all while practicing medicine. This can be a great way to reignite your passion for your profession by experiencing new healthcare environments.
Locum physician job also provides opportunities to travel to desirable geographic locations. If you’ve always wanted to explore new cities or regions, why not get paid while doing so? With positions available nationwide, you can choose where you work, whether you prefer staying closer to home or traveling to new and exciting places.
One of the most immediate financial benefits of locum work is the opportunity to earn extra income. Whether you’re paying off student loans, managing debt from opening your own practice, or looking to boost your savings, a locum job can provide a reliable stream of additional revenue.
Doctors can adjust the amount of work they take on, depending on their financial goals. If you need to make a significant dent in your student loans or other debt, you can increase your locum hours.
Working as a locum physician gives you the unique opportunity to experience a variety of healthcare settings. This exposure helps you improve and diversify your skills. You’ll get to work in different specialties, practice in diverse clinical environments, and collaborate with various medical teams, each offering new learning experiences.
Moreover, locum doctor jobs allow you to try out different healthcare facilities before deciding on a permanent job. This can help you find the ideal work environment and refine your preferences when it comes to patient care, work culture, and medical specialties.
Finding the right locum job is crucial for maximizing the benefits of this career option. Working with a reputable medical staffing agency can streamline the process, making it easier to match with positions that align with your skills, preferences, and schedule. These agencies maintain extensive databases of available locum jobs, and they can help you find opportunities that best fit your lifestyle.
By working with a staffing agency like ProLocums, you can save time and effort searching for positions, and you’ll benefit from expert guidance in navigating the locum job market. Whether you’re interested in staying close to home or using your schedule to travel, there are countless opportunities available to you.
Locum positions are an excellent option for physicians seeking flexibility, additional income, and the opportunity to explore new environments. Whether you're looking to pay off debt, improve your skills, or reduce burnout, locum jobs allow you to create a fulfilling and balanced career. By finding the right placement and managing your schedule wisely, you can enjoy the benefits of locum jobs while maintaining a positive work-life balance.
If you’re considering taking on locum work, get in touch with a trusted staffing agency like ProLocums to help you find the perfect position for your needs.
11/19/2024
Finding skilled physicians to address your staffing needs can often be a challenging process. Whether you’re dealing with a temporary vacancy, a seasonal influx of patients, or a persistent staff shortage, hiring locum tenens physicians can provide an efficient and beneficial solution.
Locum tenens physicians work on a temporary or contract basis across multiple healthcare settings. Their role is crucial in maintaining continuous patient care, alleviating the workload of your permanent staff, and bringing new expertise and fresh perspectives to your team.
According to the 2023 State of Locum Tenens Report, experts forecast steady growth in the locum tenens market, driven by clinician shortages and the need to catch up on treatments deferred during the COVID-19 pandemic. In fact, the locum tenens staffing segment, valued at $22.5 billion in 2022, is projected to grow at an annual rate of 5.7% from 2023 through 2030.
Bringing locum tenens physicians into your healthcare organization offers numerous advantages including flexibility, high standards, and cost efficiency.
However, hiring locum tenens physicians comes with its own set of challenges, especially when it comes to credentialing. Understanding and efficiently managing the credentialing process is key to ensuring a smooth and successful hire.
Credentialing is the process of verifying a physician’s identity, qualifications, and competence before they are allowed to practice at a healthcare facility. This step is vital for maintaining high standards of care, protecting patient safety, and ensuring compliance with regulatory requirements.
When hiring locum tenens physicians, the process of medical credentialing service typically involves two stages. First, the locum tenens agency like ProLocums conducts internal credentialing to ensure the physician meets general standards. Then, the healthcare facility where the physician will be working completes external credentialing specific to the job.
The credentialing timeline can vary, often taking anywhere from a few weeks to several months, depending on the complexity and urgency of the case. Delays in credentialing can be particularly challenging for healthcare facilities facing an immediate staffing shortage. Streamlining this process, even slightly, can result in significant improvements to your facility’s operational efficiency and return on investment (ROI).
Before you begin your search for locum tenens physicians, it’s important to ensure that your facility is ready to integrate them smoothly.
Clearly define your immediate and future staffing requirements, including the specialization, skills, and experience. Determine a realistic budget for hiring locum tenens physicians, considering factors such as travel, accommodation, malpractice insurance, and agency fees.
Partnering with a reputable locum tenens agency like ProLocums that specializes in your area and has experience with your location is crucial. Conduct thorough interviews to evaluate each candidate’s qualifications and compatibility with your facility’s culture. Always check references and verify credentials before making a final decision. Choose the candidate who aligns most closely with your needs and expectations.
Once you’ve selected the right physician, it’s time to initiate the credentialing process. Key steps include:
While credentialing is an essential part of the hiring process, it can be time-consuming and complex. Technology solutions like ProLocums can simplify and expedite credentialing. By automating manual tasks, ProLocums can dramatically shorten the credentialing timeline with real-time status updates and easy access to credentials, which can enhance the overall experience for both physicians and healthcare facilities.
In summary, onboarding locum tenens physicians can be a strategic solution for addressing staffing challenges in healthcare. By preparing your facility, carefully selecting candidates, and streamlining the credentialing process, you can ensure that locum tenens physicians are seamlessly integrated into your team and contribute to the delivery of high-quality patient care. For more information visit Prolocums.com
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