Why Credentialing Compliance is Critical for Long-Term Care Facilities

Managing a long-term care (LTC) facility can feel like juggling multiple responsibilities—resident care, staff management, tight budgets, and a labyrinth of regulatory requirements. One of the most critical areas you cannot afford to overlook is credentialing compliance. This isn’t just about checking off boxes; it’s about protecting your facility from financial penalties, minimizing disruptions, and ensuring your residents receive top-quality care.

In this blog, we’ll explore why credentialing compliance is so crucial for nursing homes and what actionable steps you can take to stay ahead.

Credentialing Compliance: More Than Just Paperwork

Credentialing compliance often seems like a mountain of paperwork, but its implications go far beyond administrative tasks. The credentials of your staff—whether nurses, administrators, or healthcare aides—are directly linked to their ability to provide care. Missing a renewal deadline or failing to verify a key document can lead to significant consequences, such as:

• Financial Penalties: In many states, nursing homes are required to verify that staff and contractors are not on exclusion lists like the OIG’s List of Excluded Individuals/Entities (LEIE). Failing to keep credentials updated can result in hefty fines or even exclusion from Medicare and Medicaid programs. For example, under Civil Monetary Penalty Law (CMPL) (42 U.S.C. § 1320a-7a) employing or contracting with excluded individuals. Under this law, nursing homes can be fined up to $10,000 per item or service improperly claimed, along with treble damages (three times the amount claimed). Nursing homes are required to repay all federal payments received for services provided by excluded individuals. This includes repayment of Medicare, Medicaid, or any other federal healthcare program reimbursements​
• Staffing Disruptions: Imagine you’re short on nurses, and at the last minute, you discover a key staff member’s license has lapsed. This could lead to understaffing and place undue pressure on the rest of your team, resulting in diminished quality of care. Staying on top of credentials ensures your team can continue to operate smoothly.
• Resident Safety: Ultimately, the quality of care is directly tied to the qualifications of your staff. Credentialing compliance ensures that your employees meet all necessary safety standards, from CPR certification to background checks. This directly impacts the well-being of your residents. 

The Credentialing Challenge: Managing Thousands of Deadlines

Credentialing compliance sounds straightforward—of course, you want your staff to be qualified and your facility to avoid penalties. But the administrative burden of tracking these credentials can be overwhelming. Let’s look at the numbers.

LTC administrators typically manage between 2,800 to 4,000 credentialing due dates per year for just 100 employees. That’s roughly 250 deadlines each month! These due dates include everything from professional licenses and CPR certifications to vaccination renewals and privacy agreements.

Here’s a small sampling of what you need to track:

• Professional Licenses: Renewal every 2 years
• HIPAA Certifications: Annual
• CPR and BLS Certifications: Renewal every 2 years
• Vaccination and Immunization Records
• Background Checks: OIG Exclusion checks quarterly or monthly

Each of these due dates comes with reminders, documentation, and follow-ups, all of which need to be managed efficiently. Multiply that by the number of employees in your facility, and it’s easy to see how quickly things can spiral out of control.

Automating Credentialing Compliance: The Solution

About 50% of work today is automatable. [source: McKinsey & Company - Jobs lost, jobs gained: What the future of work will mean for jobs, skills, and wages]

Manually tracking thousands of credentialing due dates is not only time-consuming but also prone to human error. This is where automation can be a game-changer. Credentialing software, such as Perla, designed specifically for the LTC industry, takes the burden of tracking and managing credentials off your shoulders.

Here’s how automation can revolutionize your credentialing process:

• Real-Time Alerts and Reminders: With Perla, you’ll never miss a deadline. The platform tracks upcoming credential renewals and sends automatic notifications, ensuring that both administrators and staff are always in the loop. You no longer need to rely on error prone manual reminders or last-minute scrambles to meet deadlines. 
• Streamlined Documentation: All certification, license, and verification documents are stored securely in a digital database. Employees can access documents remotely and safely. This eliminates paper trails and lost documents. When an audit or compliance check comes, everything you need is easily accessible.
• Task Delegation and Accountability: Administrators can assign credentialing tasks directly to employees through the system. Employees receive notifications of what they need to complete and when, making them more accountable. Automated follow-ups ensure that tasks are completed on time, reducing the administrative burden on HR teams.

ROI: Time Savings, Reduced Stress, and Revenue Protection

Investing in credentialing compliance software like Perla may seem like an additional expense, but the return on investment is significant. Tracking 250 credentialing deadlines per month manually can take hours of administrative work, not to mention the potential for costly human errors. Automation dramatically reduces the time and effort required, ensuring that no due date slips through the cracks.

Here are some of the benefits LTC facilities can expect:

• Time Saved: Administrators spend less time chasing down documents and managing schedules, freeing up hours that can be focused on higher-value activities.
• Stress Reduction: With automation, the constant worry about missing important deadlines is eliminated. Perla provides real-time updates and reminders, taking the pressure off your administrative team.
• Revenue Protection: Avoiding penalties and ensuring that staff are always certified means your facility can continue operating smoothly without risking revenue from Medicare or Medicaid.

Ensuring Resident Safety and Quality Care

Beyond ROI, the true value of credentialing compliance lies in its direct impact on resident care. Certified staff are better equipped to handle emergencies, administer medications properly, and deliver high-quality care. Credentialing compliance ensures that only qualified staff are entrusted with the health and safety of your residents.

Actionable Steps for Your Facility

How can you ensure that your facility stays ahead of credentialing compliance?

1. Audit Your Current Process: Take a thorough look at how you’re managing credential renewals today. Are you tracking them manually? Are reminders slipping through the cracks? Identifying gaps is the first step to improving your system.
2. Invest in Automation: Consider implementing credentialing software like Perla that caters to LTC facilities. Automating your credentialing processes will save time, reduce human error, and give you peace of mind.
3. Train Your Staff: Make sure your staff understands the importance of maintaining their credentials. Empower them with self-service tools to upload their certifications and track their own due dates.
4. Stay Informed: Regulations are always changing. Keep up-to-date with the latest compliance requirements for your state, and partner with a compliance expert if needed to ensure you’re not caught off guard. 

By taking these steps, your facility can avoid the pitfalls of non-compliance and continue delivering the high-quality care your residents deserve. In the end, credentialing compliance isn’t just about avoiding penalties—it’s about ensuring that your staff is always prepared to provide the best possible care.

‍