A New Legislation in Pennsylvania will Change Credentialing for Doctors and Practitioners
While
the healthcare industry is on an upward spiral, a mounting number of
stakeholders are still grappling with various problems triggered by the
complexity of credentialing and other financial compliances. Dealing with
different operational challenges involved in efficiently managing complex
multi-party arrangements for accelerating licensing and credentialing process
for private practitioners and healthcare providers.
However,
a new senate ruling was recently enforced in Pennsylvania, which focuses on
making the credentialing process foolproof for healthcare service providers by
eliminating the potential for unnecessary delays for credentialing applicants
to be a part of health insurance organizations.
Representative
Clint Owlett (R- Bradford, Tioga, Potter) introduced House Bill 533 in the
Pennsylvania House in November 2019, and it was passed unanimously (190-0). The
legislation addresses a wide range of processes involved in the application of
credentialing that must be completed by healthcare providers for becoming
credentialed by a health insurer.
While
insurance companies continue to impose their own time frames throughout the
entire credentialing process a healthcare practitioner has to follow, the new
legislation is expected to give this process a distinct deadline and a
predictable timeframe. The senate ruling is expected to enable the Pennsylvania
Medical Society and the ecosystem of healthcare practitioners and hospitals in
the state to get credentialed by insurance companies faster.
The
credentialing process that is currently followed in the healthcare industry in
the region takes over six months for healthcare service providers to get
credentialed. However, according to the new legislation, insurance companies
will be enforced to finish the entire process of issuing a doctor’s credentials
within 60 days, and failing to do so will lead to issuing a written explanation
of the reasons behind it. This is expected to expedite credentialing processes in
Pennsylvania, changing the future trends in the healthcare industry as well as
the healthcare insurance landscape.
The new
legislation is likely to have a significant impact on how the healthcare
industry operates in rural areas, as rural hospitals are always struggling to
get qualified doctors and physicians. As credentialing and licensing are
closely associated with how telehealth initiatives are implemented in rural
communities, the new legislation will facilitate rural hospitals to effectively
streamline their timelines of onboarding and credentialing process for new and
experienced physicians.
Taking
into consideration the probable impacts of the new Bill for credentialing
passed in Pennsylvania, more states in the United States are likely to ride on
its coattails and impose similar regulations, in the coming years. Furthermore,
as it supports rural hospitals to boost the onboarding and credentialing of new
doctors, the new regulation will create new profit-making opportunities for
stakeholders to improve their organizations’ financial health.
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