credentialing services

When does outsourcing your credentialing make sense?

As we all know, healthcare facilities exist to facilitate and administer medical care to their patients. While we have advanced like never before in our cure rates, infection prevention, disease management, OR efficiency, and nearly every other available metric, the roadblocks to actually running a successful practice have done nothing but increase in size. Every practice, regardless of its size, is faced with a daily barrage of challenges that aim to prevent or limit the practice’s payment for services. Within the revenue cycle, physician credentialing and insurance enrollment represent the first obstacle in obtaining timely payments, and this is what we’d like to cover in this article. As you likely know, insurance credentialing or provider enrollment has evolved over the years to be one of the most complicated and confusing processes within any industry. In this article, we’ll review three reasons why outsourcing your credentialing and enrollment department could make your revenue cycle more efficient and your practice more profitable.

Reduced Labor Costs

This is pretty self-explanatory, and we challenge you to take a close look at what the credentialing and enrollment process is actually costing your organization. In all likelihood, the person tasked with handling your insurance enrollment and credentialing also has a number of other responsibilities within the organization. Unfortunately, these other responsibilities (while they may be important) typically supplant enrollment and credentialing needs as the top priority. With declining reimbursements and rising costs, most practices are forcing more and more on their limited number of employees. While we agree with watching labor costs and distributing work across the practice, it’s critical that certain compliance and credentialing requirements remain at the top of your staff’s to-do list. If you look closely, you will very likely find that your current staff’s workload is unsustainable and is resulting in unnecessary overtime and errors. By outsourcing to a professional organization, you not only reduce the stress level on your current staff but also ensure the top priorities of your organization do not get shuffled to the bottom of the stack. One error or misstep within the credentialing process could literally bankrupt your practice. We have seen it happen numerous times over the years. Whether it’s a Medicare revalidation ignored resulting in the deactivation of PTANs or recredentialing requests that are tossed and result in termed contracts, you don’t need this added liability. By choosing to outsource credentialing services, you ensure that all tasks are handled by professionals dedicated solely to this function.

Increased Efficiency

Efficiency is key within every industry, and healthcare is no exception. If you’ve been running a practice for any length of time, you know that the credentialing and enrollment process often feels like you’re walking in a maze with a blindfold on. Credentialing professionals get out of this maze by relying on advanced technology and payer relationships. An example of this would be a professional credentialing organization’s ability to bypass the 800 number of a provider enrollment department and go directly to a regional network manager. The relationship that bypasses the customer service department usually results in at least 30 days shaved off of the entire credentialing process. In addition to the relationships, advanced technology utilized by professional credentialing agencies ensures the accurate and timely submission of all applications and forms. It also ensures that the correct forms are used and delivered to the correct address, fax number, or email. These credentialing services are designed to streamline the process and prevent delays.

Eliminate Risk of Turnover

Turnover happens, regardless of how amazing your organization is. When it occurs, it usually happens at the worst possible time, not when you can afford to lose someone. How will your organization be affected by turnover in your RCM or credentialing department? Our company is no exception and has had to deal with turnover in the past ten years. The difference is in our ability to effectively deal with turnover through our commitment to cross-training and disciplined project accountability/tracking. These commitments ensure that management is never left in the dark regarding the status of an account and anyone, at any moment, can pick up where someone else left off. Outsourcing credentialing services to a reputable vendor eliminates the risk associated with turnover and ensures continuity in your revenue cycle.

Expertise and Compliance

Another significant advantage of outsourcing credentialing and enrollment is the level of expertise and compliance that professional organizations bring to the table. Credentialing firms stay up-to-date with the latest regulatory changes and payer requirements, which can be a daunting task for in-house staff juggling multiple responsibilities. This specialized knowledge helps to avoid costly mistakes and ensures that your practice remains compliant with all necessary regulations. Moreover, professional credentialing providers often have established relationships with insurance companies and regulatory bodies, which can expedite the entire process and lead to quicker approvals. This ensures that your providers are credentialed accurately and promptly, reducing the risk of denials and delays in payment. Working with credentialing providers can provide your practice with a competitive edge by ensuring compliance and efficiency.

In summary, outsourcing your credentialing and provider enrollment is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something serious really worth it? That’s really what you must ask yourself. Are you certain that your current credentialing needs are being handled efficiently or being done incorrectly by someone who lacks proper training or experience? Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days, whereas most of our payers are completed in 90 days. Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.

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