Module 06 Written Assignment - Presentation

Joyful Hospital Executive Summary

Student Name

Institution Affiliation

Joyful Hospital Executive Summary

Overview

Credentialing a healthcare provider is the project process through which a medical organization verifies that potential service providers have the necessary licenses, qualifications, and abilities to offer high-quality patient care. To maximize profit, Joyful hospital is focused on the quality of care rather than the quality of service, as the emphasis on cheap care grows (Leung et al., 2020). As a result, the hospital readmission program is a set of policies targeted at improving healthcare quality and reducing readmissions. The focus and determination in the facility is directed towards getting the healthcare providers credentialed. The providers that undergo credentialing in the healthcare facility include the physicians, nurses, physical therapist, pharmacist and psychiatrist.

The problem

The problem is significant in a manner that the healthcare providers need to be credentialing in order to make sure that they meet the required standards. The healthcare providers and the healthcare facilities are not credentialed. The target audience includes the nurses, physicians, pharmacist, psychiatrist and physical therapists. The healthcare facilities are also targeted in order to be credentialed. By making sure that it has adhered to the requirements.

The Solution

The credentialing of the healthcare provider is important because it makes it possible to receive the in-network reimbursements from the insurance plans. The process of establishing that medical practitioners have the necessary qualifications to execute their duties is known as provider credentialing. This necessitates contacting a variety of organizations, such as medical schools, licensing boards, and other authorities, to ensure that the providers have the necessary licenses and certificates (Leung et al., 2020). Furthermore, the credentialing organization verifies that the providers have no previous known difficulties that indicate they are incapable of successfully treating patients. The standard application of the credentialing is done by applying the three phases that ensure that the information used for the process is accurate. There is the need for an on-site visit to ensure that the facility that we are using for the healthcare service is up to the required quality standard. There is the need to visit the site in order to make sure that the healthcare providers will be working in an environment that is favorable for offering care. The provider credentialing process takes three phases that include gathering information, checking the information and awarding the provider with credentials. A healthcare facility or health insurance plan may inquire about the provider's background, licensure, schooling, and other credentials (Leung et al., 2020). The information can be sent via email or software in the form of a questionnaire. In some circumstances, a third-party entity known as a credentials verification organization (CVO) collaborates with the healthcare facility or insurance company to obtain and verify information. CVOs are frequently hired by companies to help with credentialing. In many circumstances, the background check will be done by the institution or the insurance provider (McMullen & Howie, 2020). They will communicate directly with licensing organizations, medical schools, and other bodies to verify the information provided by the provider. In other circumstances, the facility or insurance company may utilize credentialing software to monitor information made public online by licensing organizations and other groups. Verification checks may also be performed by the CVO. Many healthcare businesses rely on collaboration and work management tools to help them organize and record provider information, as well as receive automatic updates when credentials expire or need to be re-checked (Leung et al., 2020). The successful process of credentialing would result to the healthcare provider team to receive the NPI that verify their approval to offer healthcare services. The healthcare facility grants credentials to the provider after verifying all relevant credentials and finding no negative issues. After completing a similar process, the health insurance company can determine whether or not to approve the provider as an in-network provider (McMullen & Howie, 2020). In other words, the insurance company will reimburse the provider for treating patients who are covered by the policy.

Highlights

The image indicates the checklist of the requirements in order to have a successful credentialing of all the healthcare providers within the healthcare facilities. A healthcare provider would be considered credentialed after completing the requirements and meet the requirements.

Key to Success

The success of the project is achieved through a successful marketing and awareness processes through the social media platforms and also the organization website where all the healthcare providers can access.

Finances

The source of finances for the process is sourced from both the federal and state government that imposes the regulation about the credentialing.

References