How much does physician credentialing cost?
The costs for 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.
- 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 focus required to do this right is one of the primary reasons we advocate outsourcing this critical process. You can certainly do it in-house, but it requires you respecting the credentialing department and limiting what you add to their plate as they work on enrolling you with the payers. If you want to limit mistakes, you must treat them as if they’re surgeons where one error is too costly to risk.
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. Medicare average is only 55 days due to our contacts within the different Medicare administrators.
How much revenue are you losing?
|Specialty||Lost Facility Revenue|
Lost Physician Revenue
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.