Image by Mohamed Hassan from PixabayCredentialing quality can significantly impact ambulatory surgery centers (ASCs) during the onboarding process of new physicians.
When not managed properly, it can lead to delays in provider start dates, which result in lost revenue and patient dissatisfaction. Credentialing involves more than just verifying licensure; it also impacts reputation, risk management and recruitment.
During a recent ASC News webinar, experts from MedTrainer and Ambulatory Healthcare Strategies discussed how automation is key to streamlining processes, reducing errors and ensuring regulatory compliance, ultimately improving ASC operations and patient care.
Yet ASC leaders need to remember that credentialing is more than just a checklist, the experts from MedTrainer and Ambulatory Healthcare Strategies pointed out. Missing a payer enrollment can result in a loss of $50,000 to $100,000 in revenue for a single surgeon in one month, according to Joyce Siow-Yazzie, a credentialing solutions consultant at MedTrainer.
MedTrainer provides instant access to documents and automated workflows, supporting regulatory compliance and the delivery of high-quality patient care. The Las Vegas-based company serves more than 3,000 health care providers across 15,000 facilities nationwide.
Credentialing also influences an ASC’s reputation, Siow-Yazzie said, with surgeons comparing onboarding times between ASCs; those with more extended onboarding periods may lose talent.
“Credentialing is your foundation; it’s the primary source verification of education, training, work history and malpractice coverage,” Katie Pierson, a regulatory specialist at Ambulatory Healthcare Strategies, said during the webinar.
Ambulatory Healthcare Strategies, based in Rochester, New York, offers regulatory and compliance assistance to surgery centers across the country.
The domino effect
One consequence of poor credentialing is its impact on enrollments. Enrollments tend to be problematic because they affect two different areas, according to Siow-Yazzie.
Facility-side enrollments authorize the ASC to bill for services provided in the operating room (OR), such as equipment use, nursing staff and supplies. Provider enrollments authorize each surgeon, anesthesiologist or other practitioner to bill for the professional services they perform on the patient.
“Enrollment generally poses a risk if there is no revenue coming in; the primary risk of enrollment gaps is either the facility or the provider not being enrolled with the payer,” Siow-Yazzie said. “That means claims cannot be paid, so the ASC’s entire revenue cycle could be held hostage by the credentialing and enrollment processes.”
Revenue issues almost always start from a domino effect that leaders often don’t recognize until later, according to Pierson.
Surveyors may find missing paperwork, which can result in a citation. If the problem is systemic, it can grow from a simple finding into a significant deficiency, prompting the ASC’s governing body to get involved. That delay can make credentialing unnecessarily more difficult. This causes hidden costs of poor credentialing, such as losing cases when physicians go elsewhere, wasted staff time and loss of trust.
Every delay in credentialing or privileging pushes back a provider’s start date. When cases sit idle, revenue is lost, Pierson said. If the provider is already working, incomplete files can cause denied claims that may not be noticed for weeks. By then, the staff have been paid and OR times have been used.
Balancing financial realities with regulatory requirements can ultimately affect an organization’s reputation, Siow-Yazzie noted.
“Reputations are everything for an ASC,” she said. “Your reputation isn’t just about surgical outcomes. It’s about the financial experience you deliver. Those billing errors or surprise out-of-network charges don’t just frustrate patients. They are amplified across referral networks or appear in online reviews. That is the reputational ripple effect. This is where a streamlined, efficient credentialing process can become an ASC’s strongest reputation defender.”
Effective onboarding protects patients by confirming that a surgeon and facility are in network before scheduling, ensuring a smooth financial process. It also sends a clear message to surgeons that the ASC operates professionally and efficiently. Additionally, it safeguards the brand by preventing financial mistakes that could lead to negative reviews and helps maintain the trust of referral sources.
A plan for success
High-performing organizations treat credentialing as a strategic function, not just paperwork, according to Siow-Yazzie.
They include credentialing as a regular agenda item in meetings with their governing body and during quality reviews.
ASCs that manage credentialing effectively invest in staff training and dedicate time to credentialing tasks. They also leverage credentialing data to inform recruitment, staffing and quality improvement efforts.
Most importantly, these ASCs hold leadership accountable. Executives are always aware of the status of every provider within their organization.
Some quick wins for ASC leaders in credentialing include monthly audits of documentation with expiration dates, according to Siow-Yazzie. Conducting quarterly credentialing reviews and monitoring timelines can help ensure that credentialing and privileging staff stay on track, protecting the organization’s bottom line and reputation and ultimately reducing patient risk while increasing patient and surgeon satisfaction.
“Credentialing is the foundation of safe, compliant care,” Pierson said. “It’s what gives your governing body the confidence to grant privileges and protect your patients. It touches every part of your ASC – revenue, reputation, risk and recruitment. When you streamline the process, you don’t just organize files better; you speed up onboarding, boost performance and set your ASC up for growth.”
