Credentials anyone?
Credentialing healthcare professionals is a universally problematic process, not only for providers but also for payers. It is a necessary process to limit fraud in many cases. The process often requires four to six months to complete and directly impedes the ability for a healthcare professional to deliver care and be reimbursed for their work. Hospitals alone forfeit an average of $7,500 in daily net revenues waiting for credentialing and payer enrollment processes to be completed. Furthermore, nearly every organization who is required to perform this work does so independently which creates a significant administrative delay and burden for practitioners. The costs and delays make this another critical area in need of reform and streamlining.
Few other businesses must front so much money with limited guarantee of when or if they can have a return on their investment. Providers can leave an organization for many reasons and this can occur before credentialing is completed shortly thereafter making the cost of the process even greater. It is speculated that some practitioners can even game one organization before moving to another ant this may just a red herring. The need for a secure,interoperable, electronic credentialing system between payers, Medicare and each state for Medicaid, and commercial payers is critical. The cooperation of practitioners and provider organizations is also critical for the system to work. This all must be done without adding just another hoop for providers to jump through with additional cost and delays. A standardization of credential acceptable to all payers is needed.
Exchange?
An exchange could be set up for trading and verifying credentialing information between healthcare organizations and payers to reduce the choke points. Leveraging the technology of blockchain, data science,and artificial intelligence to simplify the acquisition and verification of information related to professional credentialing and identity can be accomplished with the goal of reducing the frustrations and cost for all involved. Another project for ONC? The exchange is not a novel idea.