This is no easy feat, maintaining a smoothly running healthcare operation. For healthcare providers, they are usually stretched thin between providing quality care to meeting administrative demands. Credentialing is often left to the side of the chaos. Credentialing is vital for the evolving physician as well as for patient safety and meeting compliance standards through the delivery of care.
However, the process can be enormously time consuming and complicated. And that’s why today, more and more healthcare providers are approaching outsourcing of credentialing services.
Learn more below about what credentialing is, the issues with current processes and how outsourcing might change the way your practice operates.
What is Credentialing and Why Does It Matter?
Healthcare provider credentialing is the process for verifying an education, training, licenses and work experience. This has a great importance for the patient’s safety, quality standards of care, as well as for compliance with regulatory requirements.
Besides insurance companies, hospitals, and other healthcare institutions, firms who are looking to use a provider services also need to confirm that he or she is competent and can deliver services. Credentialing is important to providers in that it helps secure relationships with insurance companies, gain hospital privileges, and earning patients’ trust.
To put it simply, it is an important aspect of modern healthcare operations, but it can be grindingly difficult to manage.
The Traditional Credentialing Process
Typically, the process involves gathering massive documentation from healthcare providers, which includes copies of diplomas, licenses, certificates, references, and work history. Then this data has to be minutely verified against primary sources like medical schools, licensing boards, and previous employers.
On top of that, credentialing often entails regular monitoring to make sure the certification as well as the license is current. Due to the volume of paperwork involved, the need for accurate verification, and the various other parameters of insurance networks and state regulations, in-house credentialing can be a black hole of time and resources. Often, too much time can be lost in a provider’s enrollment with insurance companies, and the revenue cycle can be affected.
In addition, when staff is already at capacity, fulfilling their duties, the likelihood of errors or missing information rises. These challenges expose a credentialing process that is lacking in efficiency, which is why many healthcare organizations are now embracing outsourcing as a way to solve this problem.
Handling credentialing internally involves a labor-intensive, manual process. Here’s what healthcare practices often face:
- Collecting and organizing provider information, such as diplomas, training certificates, and licenses.
- Multiple insurance payer and credentialing body documentation submissions.
- For applications to be processed on time, it requires regular follow-ups.
- Handling re-credentialing for existing providers to maintain compliance.
The Benefits of Outsourcing Credentialing Services
Outsourcing physician credentialing services is a great way for healthcare providers to regain time, improve accuracy, and significantly reduce headaches. Here’s how it can make a difference:
1. Improved Accuracy and Efficiency
Credentialing requires close attention to detail. It’s always a better choice to get it from an expert. Through the implementation of specialized software, optimized workflows, and rigorous testing, professional credentialing services have achieved unparalleled efficiency in application processes. As a result, claims are less likely to be denied on credentialing grounds since gaps will be reduced.
2. Lower Costs and Reduced Administrative Burden
When you manage credentialing in-house, you spend time and resources on paperwork. By outsourcing, your team can concentrate on its most important work—patient care. Furthermore, using an outside partner means healthcare practices don’t have to fork over the cash for extra administrative staff or hefty credentialing software.
3. Better Compliance and Accreditation
There is no negotiation around compliance with state, federal, and insurance regulations. These credentialing service providers keep you up to date about these requirements so your practice stays compliant. By reducing your risk of audits, fines, and revoked accreditation, it is far better.
4. Streamlined Connectivity with Payors
Enrolling providers at the maximum number of payors efficiently is a key benefit of outsourcing. These services make it much easier to connect providers with the right insurance and ensure payments go through smoothly.
5. Faster Payments and Fewer Denials from Insurance Companies
Delays in credentials can delay reimbursements. Expert professionals of these services speed the enrollment process, expedite payments, and minimize the chance that claims will be denied. They assist providers in keeping their revenue cycle healthy and predictable.
6. Up-to-Date Data Management
Credentialing is a process that isn’t done and forgotten; credentials must be updated regularly in order for you to remain current with payors and governing bodies. Outsourced providers ensure that all data, from licenses to certifications, stays current. This proactive approach also gets around the chance of lapses that could cause delays or penalties.
7. Increased Patient Referrals
A quick credentialing process enables providers to get connected faster to insurers. It also makes it easier for patients to refer you, directly boosting your practice’s patient base and revenue.
Elevate Your Credentialing Process Today!
Credentialing doesn’t have to be a headache. Outsourcing to a capable partner frees up health care providers to concentrate on offering incredible care without wasting time or resources. It’s hard to ignore the efficiency, accuracy, and cost-saving opportunities provided by professional credentialing service provider.
Let’s work together to streamline your operations and explore ways to make things run more smoothly. Book your free consultation with Doctor Management Services and see how we can help you achieve your goals.