The Credentialing Knowledge Gap
Be honest, do you know what genetic counselor credentialing is, and why it matters?
According to the 2020 Professional Status Survey (PSS), only 33% of genetic counselors reported having either institutional or payer credentialing. When asked “Are you credentialed by your institution?” over 20% responded that they were “not sure”. Further, roughly half of those credentialed reported being unaware of how credentialing impacted reimbursement for their services or billing of third party payers.
These responses suggest a need for increased education on the benefits of credentialing and how to discuss credentialing within one’s institution.
Test your knowledge of GC credentialing!
- Which of the following is a primary goal of institutional credentialing?
- Reduce cost to the institution
- Enhance protections for patients to ensure practitioners are qualified
- Increased burden of risk management
- Create barriers to care
- Which of the following statements about credentialing is true?
- Credentialing regulates services at the state level and defines scope of practice
- The majority of institutions only credential doctorate-level (MD and PhD) practitioners
- The primary purpose of credentialing is to ensure that a regional market is not over-saturated with providers
- Credentialing enables institutions and payers to verify that practitioners are trained to provide services patients
- Why is payer credentialing necessary?
- A patient cannot be scheduled with a provider unless they are credentialed
- Ensures that members have access to practitioners that meet payer standards
- Allows for an additional processing fee to be charged when patients are seen with a credentialed practitioner
- It is the only time a health system or practice can verify a practitioner’s education, certification and license or perform a background check
Answer Key: 1(B), 2(D), 3(B)
If you missed two or three answers, it’s time to brush up on GC credentialing.
The Importance of Credentialing
Some of the specific benefits of credentialing include:
For your institution
- Some institutions require healthcare practitioners to be credentialed to see patients and/or document in authorized medical records.
- Some payers require practitioners to be credentialed. This may increase reimbursement for services.
- Credentialing protects patients by ensuring that practitioners are highly qualified.
For genetic counselors
- Along with licensure and federal advocacy efforts, credentialing is part of our profession’s push for improved reimbursement and greater recognition within our institutions and the healthcare system.
- Credentialing is generally required for genetic counselors to be reimbursed as a professional service, obtain in-network status with payers, and appear in payer directories.
- Institutional credentialing policies protect practitioners and institutions from liability.
Uncertain if you are credentialed at your institution or by payers? Take the initiative to learn more. Providing accurate data in the PSS is critical to advancing our organization.
Learning More & Next Steps
Whether you have ten minutes to spend on a quick overview, or a few hours to spend on a deeper dive, we have a resource for you! The NSGC Access and Service Delivery Committee has developed several resources to help genetic counselors better understand the benefits and process of credentialing. To learn more, check out the Healthcare Business Resources page on the NSGC website and the Credentialing: How and Why course in the Online Education Center.
Lastly, if you don’t yet have credentialing or if you aren’t sure if you have it, consider starting a conversation about credentialing with your supervisor, administrators, or institution.