Do you have a fail-proof system or process firmly in place to monitor your medical credentialing expirable data? Do you know what data needs to be monitored and why?
Have you ever considered that if you don’t have a sufficient and technology driven solution to managing your data that you run the risk of a disastrous situation? Having a system track and monitor this data minimizes your costs and reduces losses in revenue while also decreasing turnaround time for provider credentialing.
The following are five KEY expirables that should be monitored and why:
- Medical Licensure – For every state you practice in, you must hold an unrestricted
and active license to practice and each state board requires that you renew your license every 2-3 years. If your license isn’t renewed by its expiration date, you can’t practice and if you do practice without an active license, you run the risk of many legal ramifications.
- DEA – Your DEA Registration has an expiration date and is required to be renewed
every three years. If you fail to renew your DEA registration, your prescription writing ability for schedule four drugs will be revoked. The loss of your DEA license can lead to fines and even sanctions by the medical board for writing prescriptions without a valid DEA. This lapse can also lead to an increase in your malpractice benefit premium.
- CAQH – The CAQH is a database most providers are familiar with. This database is used by most insurance payors for medical credentialing you into their network. If you don’t keep all of the information in your CAQH profile current and also don’t re-attest the validity of this information by the attestation expiration date; the payers could stop paying your claims. For example, if you allow your CAQH to expire and Humana runs a check of CAQH and your attestation is expired, Humana will no longer issue your payments despite proper prior payor enrollment. They will begin issuing payment again, once you correct the lapse. However, if a lapse does occur, Humana and other payers may deny you a contract in the future.
- CEUs – If you do not meet the state requirements for continuing education units, you could be subject to sanction by your state’s medical board. Knowing how many you’ve obtained and how many more you have left to complete is imperative to keeping your medical license active. If you are sanctioned by the board for not completing your CEUs, this sanction will follow you your entire career. This sanction will also result in higher malpractice insurance rates.
- Malpractice Insurance – Forgetting to renew your malpractice coverage can have absolutely disastrous consequences. You would lose all hospital privileges, as well as incur additional costs in your premiums due to the lapse in coverage. You will also be obligated to report this lapse in coverage for your entire career. Even if the lapse was 15 years ago you will still be required to report the lapse. Some insurance payers may deny you a contract to see their patients due to a lapse of this kind.
Because your credentials are so important and are monitored by state boards, insurance plans, hospitals, the DEA, etc. you shouldn’t rely upon traditional methods to keep track of this data. Luckily, medical credentialing vendors have developed cloud-based software applications to streamline and automate this process.
Seek out a qualified physician credentialing & medical credentialing company that has state-of-the-art technology to monitor your expirables and offers comprehensive credentialing services as well as expirables management services.
Cynthia Young is the CEO of STAT MedCare, LLC, which is a national billing, credentialing and practice management consultant. STAT is a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation, and other credentialing related services.