How much does physician credentialing cost? | Physician Practice Specialists
credentialing costs

How much does physician credentialing cost?

The costs for physician credentialing services vary from company to company but most follow the same basic pricing guidelines. The below credentialing prices are averaged based on customer feedback and information available online.  Most companies(including ours) offers packages that cover the credentialing and contracting of a set number of plans.  We offer packages for 5 plans, 10 plans, 15-20 plans and 35 plans.  The price per plan does go down with the larger packages.

  • PPS: Credentialing packages average $200 per plan per provider. In most cases we can beat any US competitor’s price by 10-20%.
  • ThriveWorks (AKA medical credentialing .org) They are a counseling credentialing service and employ dozens of counselors across the country. Avg. $325 per plan per provider with some plans costing more.  Be sure to read the ThriveWorks reviews online.  
  • Supero Healthcare- Medicare & Medicaid $375 per provider with commercial plans costing an average of $250 per plan per provider
  • National Credentialing (nCred) – $275 per plan per provider for most plans

The time, expertise and attention to detail necessary to get credentialing done right the first time is one of the primary reasons we advocate outsourcing this critical process.  You can certainly do it in-house but please be sure that person you’re assigning this task to has actually done it before.  In most situtions, you don’t have the luxury of time on your side so on-the-job credentialing/contracting training isn’t really something you can afford.  

If you’re an established practice considering outsourcing, you’re likely wanting to know roughly how much credentialing costs your company.  This will allow you to make an informed decision when deciding to outsource or keep credentialing in-house.  We’ve covered the in-house costs of credentialing below which can be used as a benchmark when evaluating your practice.  We also have some information specifically addressing when it makes sense to turn over your credentialing to an outside company in our when to outsource credentialing article.

If you’re a new practice or just curious about pricing for credentialing services, we’ve answered that question above.

HOW MUCH IS CREDENTIALING COSTING YOUR ORGANIZATION

For this, we’ve broken down credentialing costs into two categories for facilities and providers.  We’ve identified these two categories as “direct” and “external” costs.  It’s important to note the costs associated with verifying the credentialing effective date on the facility and health plan sides are not included and are one of the primary sources of delays.

Direct Credentialing Costs are costs generally absorbed within a practice by dedicated personnel or by personnel that are primarily dedicated to other tasks (typically in the billing department).  Internal costs can be outsourced to a third party in part but will still require provider interaction to some extent.  Functions of the cost are primarily related to time spent populating applications, application review, tracking down data, tracking down documents, responding to follow up requests from credentialing bodies, signing paperwork, etc.

  • Total Cost Per Provider= $1,659.95 | This cost reflects the cost for a total of 5 insurance companies.
  • Physician ($163.96/hr) 3.4 hours $557
  • Support Staff ($19.50/hr) 31 hours $604.50
  • Technology & Hardware cost of use- $150 dollars
  • Total Per Physician Direct Costs $1,161.50 * 30% for taxes and insurance= $1,509.95 + 150= $1,659.95

“We needed to make a number of assumptions in order to complete this analysis.  The first is that the organization has a dedicated person responsible for the credentialing and that this person immediately starts working on credentialing the physician as soon as he/she signs a contract.  We typically see a 20-40 day lag time before any real work occurs from the date of signing to the date the first application is completed.  We also are assuming that the person doing the credentialing is familiar with all of the payers and their respective processes.  Failure to thoroughly understand the process for each payer will inevitably lead to delays.”

Billing Costs are hard costs associated with lost revenue from not being able to bill for charges.  Lost revenue is absorbed by both the facilities and the provider.  In some cases, a facility based practice may pay the provider an “income guarantee” while credentialing is completed, effectively transferring the provider’s lost revenue to the facility.  Below estimations are based on a 182 day average length to complete health plan enrollment, per survey.

The average time to complete health plan enrollment for PPS measured from the date we receive the provider’s information, to the effective date at the plan, is 110 days with some plans taking >180 days and others taking <90 days.  The time frame for credentialing is dependent upon a variety of factors which we can discuss with you in more detail if you’d like to schedule a call. Medicare average is only 60 days depending on the type of practice and Medicare Administrator.

    SpecialtyLost Facility Revenue

  Lost Physician Revenue

Primary Care$860,830$139,784
OB/GYN$723,600$215,112
General Surgery$1,120,571$259,756
Neurosurgery$1,493,558$462,064

 

 

As you can see, the revenue you stand to lose with an inefficient credentialing process is far more than the cost do it right internally or to outsource(as you’ll see below).  In conclusion, the cost of credentialing in-house can be both elusive and excessive.  In large groups, these costs can compound rapidly, adding to a “hassle factor” in tracking applications that adds to the costs.