Medical credentialing services is a market-driven process that aims to keep medical standards high for the benefit of patients.
As a private practice, you must ensure that the people providing services and performing treatments are credentialed correctly with your payers whenever you sign a new payer contract or hire additional practice professionals.
Unfortunately, many small to medium-sized practices, lack the robust onboard systems and procedures necessary to accurately credential new team members every time, resulting in a slew of reimbursement issues. Credentialing is critical to the health of your practice and revenue cycle because it affects revenue.
Is it, however, worthwhile to outsource to a team that does not work in your office? Let’s look at the advantages and disadvantages of outsourcing credentialing services as part of your healthcare revenue cycle consulting.
Cons of Outsourced Credentialing
The most obvious disadvantage of entrusting your credentialing services to a third party is the loss of control over the process. Some credentialing service companies don’t provide frequent or transparent reports on how they’re handling the process, and practice managers and leaders no longer handle every step of the onboarding and reimbursement process. This keeps crucial information about the practice’s financial health out of the hands of decision-makers, which can have unintended negative consequences.
When working with an external credentialing service firm, you must regularly turn over a large amount of data.
Examine whether outsourcing is still a profitable option for your practice on a yearly basis.
Benefits of Outsourcing Medical Credentialing
Make sure to partner with a well-qualified and experienced team to get the most out of outsourced credentialing.
The main advantage of using an outsourced provider rather than an in-house team is the cost savings. An in-house team requires training, salaries, and benefits.
Outsourcing provides a simple way to get up and running with new providers until you can hire an in-house team member again in an emergency when you simply need a team to handle credentialing as a stop-gap measure.
Quality Assurance is Ensured by Medical Credentialing
Patients will expect medical practices to provide high-quality care, and medical credentialing services will help to ensure that this happens.
Patients’ security is ensured
Medical credentialing services are also beneficial to patient safety because it ensures that all physicians and medical practices have the necessary skill sets to perform any procedures that are required.
Reduce Revenue Loss
Medical credentialing protects patients while also keeping money safe in medical practices. Practices are much less likely to lose revenue as a result of reimbursements that are either denied or delayed as a result of credentialing.
If medical practices allow physicians to provide services prior to the start of the credentialing process, the insurance payer may be able to backdate reimbursements to cover treatments.
Increase the number of patients in your medical practice
Physician credentialing allows medical practices to gain access to patient bases that were previously unavailable. This means that medical practices will be able to attract more patients and potentially increase their revenue.
Improve the Image of Your Medical Practice
Patients are interested in learning about the procedures used by healthcare facilities. They’ll look into the history of any healthcare facility they’re thinking of visiting. Your medical practice’s online reputation will improve if you use medical credentialing services. As a result, your practice will appear more trustworthy, and as a result, more clients will trust you.
What Are the Benefits of Medical Certification?
Medical credentialing ensures the medical industry’s quality, which benefits all parties involved. Hospitals and clinics can be confident that the person they hire will provide care that meets the highest standards. Insurance companies have an economic incentive to keep costs low, so they prefer to insure only those professionals who have demonstrated sufficient competence to practice medicine.
Medical credentialing benefits practitioners because it allows them to expand the number of patients they can serve once they receive privileges to accept clients from insurance companies. Finally, and perhaps most importantly, patients gain the knowledge that the medical industry follows strict guidelines to ensure that the health care they receive is of the highest quality.
What Impact Does Credentialing Have on Business?
Providers cannot see patients who have that insurance until their documentation is verified by the insurance company and the credential is finally awarded. Patients with that insurance will be discouraged from seeking treatment from providers outside of their network because those services will not be covered. From the perspective of the provider, no reimbursement will be available for any services rendered.
As a result, if credentialing is handled carelessly or incorrectly, it can have a negative impact on business operations. Time spent waiting for delays and issues to be resolved could have been better spent earning money.
Credentialing, on the other hand, can be a huge help to your practice if done correctly. Having an insurance company credential is like having a built-in advertising network.
Are you looking for a way to improve your insurance company’s rates?
For healthcare providers, getting credentialed and joining an insurance panel is usually a good thing. It allows them to reach a larger patient base and legitimize their practice. The disadvantage is that insurance companies sign providers to contracts that aren’t always in their best interests.
Fortunately, there is a straightforward approach to healthcare contracting. It strategizes with providers and negotiates with insurance companies on their behalf.
How can we speed up the credentialing process?
Although there are no shortcuts in the provider credentialing process, there are some best practices you can follow to ensure it doesn’t take too long. Delays have the potential to suffocate your productivity. Here are some things you can do to stay away from them:
- Don’t skip any questions and answer everything thoroughly
- If something doesn’t apply to you, make sure to write “not applicable”
- Don’t skip any questions and answer everything thoroughly
- Make sure your CV is complete and up to date, with no gaps in years.
- Don’t forget to include a copy of your certificate for Controlled Dangerous Substances.