Monday, January 3, 2011

Duplicated work in Healthcare Credentialing?

According to a 2005 MGMA survey, physicians submit an average of 18 credentialing applications every year, while non-physician providers submit an average of 8:

Think about that – a physician must submit a detailed application to a medical center or insurance company about every 3 weeks, for the rest of his career.  And unless delegating, 18 different people will perform the same credentialing activities: query the NPDB, check OIG, verify licenses, etc.

Is Aetna’s credentialing substantially different from CIGNA’s?  Does City of Hope credential better than UCLA Medical Center?  Probably not; best practices in credentialing are freely shared by Medical Staff Services professionals, encouraged by TJC and NCQA, and promoted by companies like HC Pro.

With over 700,000 physicians in the US, we’re creating millions of medical credentialing reports every year that are essentially duplicates.

MGMA’s survey didn’t separate new credentialing applications from re-credentialings, nor did it mention delegated credentialing – all of which greatly affect the amount of work performed.  Does anyone have estimates for these that can be shared?

CAQH has been instrumental in collecting and standardizing provider data, generally simplifying the application process – but they don’t address credentialing.  What do you think the next step should be to reduce the time and money spent on duplicated effort (or is the current way actually the best way)?