Companies like AVEM Health Partners understand the unique challenges that rural medical providers face. From smaller patient populations to limited healthcare resources, rural communities often struggle to maintain access to quality medical care. AVEM supports these communities by offering financial, technological, and management solutions to rural hospitals.
One major obstacle in rural healthcare is credentialing. The process of verifying and enrolling physicians with health plans is already complex, but these challenges are compounded in rural areas. This article explores six key rural healthcare credentialing challenges and how they can be addressed.
Understanding Credentialing
Credentialing is essential to ensure patient safety, maintain healthcare quality, and protect medical organizations. Physicians must complete credentialing before enrolling in health plans or practicing at healthcare facilities. A provider cannot bill insurance companies or legally practice within a medical network without proper credentialing.
Credentialing typically involves 52 detailed steps, including:
- Verifying medical education, internships, residencies, and fellowships
- Checking licenses for disciplinary actions
- Conducting background checks and malpractice history reviews
- Querying the National Practitioner Data Bank (NPDB)
Any mistake in this process can delay a provider’s ability to see patients, leading to revenue losses and disruptions in care. Rural healthcare credentialing challenges exacerbate these issues, making timely and accurate credentialing even more critical.
6 Top Rural Healthcare Credentialing Challenges
1. Limited Resources
Credentialing is usually a 52-step process that can take 90 to 120 days to complete. Credentialing requires dedicated staff, time, and financial investment. Rural healthcare organizations often lack the budget to hire credentialing specialists or invest in credentialing software. Instead, administrative staff may attempt to manage credentialing while juggling other responsibilities, increasing the likelihood of errors and delays.
Many rural facilities also struggle with outsourcing credentialing due to budget constraints, creating a cycle where providers remain uncredentialed, limiting patient access to care and reducing hospital revenue.
2. Lack of Interoperability
Interoperability is critical for effective credentialing and healthcare delivery. Interoperability is defined as the ability of computer systems to exchange and utilize information.
In healthcare settings, interoperability is a 3-pronged extension of its basic definition:
- concerns the secure sharing of digital health data without extra effort,
- facilitates the access, exchange, and use of digital health data to authorized users, and
- bans blocking the sharing and use of digital health data.
However, rural hospitals often lack the necessary infrastructure to efficiently share and access credentialing data.
A study by the Office of the National Coordinator for Health IT found that only 40% of rural hospitals query health data from external sources, and their ability to engage in digital interoperability entirely is half that of urban hospitals. This gap hinders credentialing, as providers must repeatedly submit paperwork that could otherwise be shared electronically.
3. Aging Infrastructure and Cybersecurity Threats
Rural hospitals often operate with outdated IT systems due to limited funding. Older infrastructure increases the risk of cyberattacks and data breaches, putting patient information and credentialing records at risk.
A 2021 study found that 73% of healthcare providers are using operating systems that are no longer updated, leaving them vulnerable to security threats. Despite these risks, budget limitations prevent many rural providers from upgrading their IT infrastructure, further complicating rural healthcare credentialing challenges and compliance efforts.
4. Limited High-Speed Internet Access
Credentialing relies heavily on digital applications and communications, but many rural communities still lack reliable high-speed internet. In 2019, roughly 25 million people in the United States did not have Internet access. Rural Americans are approximately 2X less likely to have Internet access than those living in urban areas. Additionally, service providers often find installing fiber-optic networks in remote areas cost-prohibitive, which can leave healthcare facilities with slow or unreliable internet connections.
Without stable internet, hospitals and clinics struggle to access credentialing databases, submit applications electronically, or communicate efficiently with credentialing verification organizations. This lack of connectivity significantly slows down the credentialing process, delaying provider enrollment and patient access to care.
5. Limited Access to Smartphones and Digital Devices
Even if internet access is available, rural healthcare workers and patients may lack the necessary devices to participate in digital credentialing and telehealth services. A 2021 study found that 20% of rural residents do not own a smartphone, limiting their ability to engage with online patient portals and credentialing applications.
Similarly, rural healthcare facilities may not have up-to-date computers or digital tools to manage credentialing efficiently. The financial burden of upgrading equipment often takes a backseat to more immediate operational costs, further exacerbating delays.
6. Staff Shortages and Time Constraints
Rural medical facilities face persistent staffing shortages, making it difficult to allocate time for credentialing. The American Medical Association (AMA) reports that only 12% of primary care physicians serve rural populations despite over 60 million Americans living in rural areas.
In addition to provider shortages, rural healthcare facilities struggle to recruit and retain administrative staff trained in credentialing. Without dedicated personnel, credentialing tasks fall to overworked employees who may lack the expertise to navigate the complex process effectively. The resulting delays can prevent new providers from seeing patients, worsening access to care in underserved areas.
Overcoming Rural Healthcare Credentialing Challenges
Addressing these challenges requires strategic solutions, including:
- Investing in digital infrastructure: Expanding broadband access and modernizing IT systems to support electronic credentialing.
- Outsourcing credentialing services: Partnering with a Credentialing Verification Organization (CVO) like 5ACVO can streamline the process and reduce administrative burden.
- Advocating for policy changes: Encouraging government investment in rural healthcare infrastructure and credentialing support programs can create long-term improvements.
- Leveraging automation and AI: Using artificial intelligence (Ai) in healthcare credentialing to automate workflows can minimize manual data entry, reduce processing times, and improve accuracy in credentialing.
- Providing ongoing training and education: Rural healthcare facilities should invest in training programs for administrative staff to stay current with credentialing best practices.
- Encouraging public-private partnerships: Collaborations between government agencies, healthcare organizations, and private companies can drive innovative solutions for rural healthcare credentialing challenges.
Conclusion for 6 Rural Healthcare Credentialing Challenges and How to Overcome Them
Credentialing is a critical but complex process that poses unique challenges for rural medical providers. While these obstacles seem daunting, they also present opportunities for innovation and improvement in rural healthcare systems.
Rural medical providers can take proactive steps toward overcoming rural healthcare credentialing challenges by investing in technology, streamlining processes, and fostering collaborations. Integrating AI, cloud-based platforms, and data-sharing networks can revolutionize credentialing, reducing inefficiencies and ensuring a smoother experience for healthcare organizations and providers.
From limited resources and outdated technology to workforce shortages and cybersecurity risks, rural healthcare organizations face numerous obstacles that can delay provider enrollment and hinder patient care.
Organizations like AVEM Health, 5ACVO, and Fifth Avenue Healthcare Services are dedicated to helping rural providers navigate these challenges. By leveraging expert credentialing services and advocating for improved infrastructure, rural healthcare facilities can streamline their credentialing processes, ensuring timely patient care and financial stability.
More information about 5ACVO
5ACVO is NCQA Credentialing Accredited, specializing in credentialing and primary source verification, and is part of the Fifth Avenue Healthcare Services family.
5ACVO sister companies include Fifth Avenue Agency (MPLI and medical malpractice insurance specialists) and Primoris Credentialing Network (credentialing and provider enrollment specialists with 54+ health plan and network provider enrollment options).
5ACVO initially published this article here. For more information on how 5ACVO can support your credentialing needs, visit 5ACVO.com or Contact Us.
