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July 13, 2023

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5 Reasons Outsourcing Credentialing Services Can Boost Your Medical Practice Revenue

If you’re a healthcare provider, you know how important it is to get credentialed with insurance companies. Credentialing is the process of verifying your qualifications, such as education, training, experience, licensing, and more, to become affiliated with a payer and be reimbursed for your services.

However, you also know how challenging, confusing, and time-consuming credentialing can be. It can take up to 120 days or more to complete the process, and any delays or errors can affect your revenue potential. Not to mention the hassle of keeping up with changing regulations and requirements that vary by state, region, or payer.

That’s why many providers choose to outsource credentialing services to a specialized vendor who can handle the process for them. Outsourcing credentialing services can offer many benefits for your medical practice, such as:

  • Faster turnaround time and reduced errors
  • Improved operational efficiency and cost-effectiveness
  • Enhanced patient safety and satisfaction
  • Increased scalability and flexibility
  • Compliance with changing regulations and standards

In this blog post, we’ll explore these benefits in more detail and show you how outsourcing credentialing services can boost your medical practice revenue. We’ll also give you some tips on how to choose the right partner for your credentialing needs.

What is Credentialing and Why is it Important?

Credentialing is the process of verifying the qualifications of a healthcare provider who wants to become affiliated with an insurance company or payer. The purpose of credentialing is to ensure that the provider meets the standards of quality, competence, and ethics in their field.

Credentialing typically involves submitting various documents and information to the payer, such as:

  • Personal identification
  • Professional degrees and certifications
  • State licenses and registrations
  • Malpractice insurance and history
  • Hospital privileges and affiliations
  • Continuing education credits
  • References and peer reviews

The payer then reviews these documents and information and conducts background checks to verify their accuracy and validity. The payer may also contact the provider’s previous employers, colleagues, patients, or other sources to obtain additional information or feedback.

The credentialing process can take anywhere from 90 to 120 days or more, depending on the payer’s policies and procedures. The provider must complete the credentialing process before they can start seeing patients covered by that payer and be reimbursed for their services.

Credentialing is important for several reasons:

  • It ensures that the provider meets the minimum standards of quality, competence, and ethics in their field.
  • It protects the patients from substandard or fraudulent care.
  • It enables the provider to access a larger pool of potential patients covered by different payers.
  • It helps the provider avoid denials, delays, or reductions in reimbursement due to lack of credentialing.

What are the Challenges of Credentialing?

While credentialing is essential for medical practices, it can also pose many challenges. Some of the common difficulties that providers face when managing credentialing in-house are:

Lack of resources

Credentialing requires a lot of time, effort, and expertise that many small and medium-sized practices may not have. 

A handful of administrative staff may not have the knowledge or experience to handle credentialing effectively. It may also require more input from the providers themselves, which takes time away from patient care.

Lack of expertise

Credentialing can be complex and confusing, requiring specific knowledge and skills. If the administrative staff lacks in-house expertise, they may make mistakes or miss deadlines that can delay or jeopardize the credentialing process. 

They may also struggle with keeping track of different requirements and procedures for different payers.

Regulatory compliance changes

Credentialing requirements can vary by state, region, or payer and change frequently due to new laws or regulations. Providers must stay up to date with these changes to ensure compliance and avoid penalties or audits. 

However, this task can be overwhelming and time-consuming for busy administrative staff who have other responsibilities as well.

Scalability issues

As a medical practice grows, so does its credentialing needs. More providers mean more paperwork, more payers, more deadlines, and more complexity. 

Managing credentialing in-house can become increasingly difficult and inefficient as the practice expands. It can also affect the internal processes and workflows of the practice.

These challenges can have a negative impact on the medical practice’s revenue potential. If credentialing is delayed or denied due to errors or omissions, the provider cannot see patients covered by that payer or be reimbursed for their services. 

What are the Benefits of Outsourcing Credentialing Services?

To overcome these challenges, many providers opt to outsource credentialing services to a specialized vendor who can handle the process for them. Outsourcing credentialing services can offer many benefits for the medical practice, such as:

Faster turnaround time and reduced errors

A specialized vendor has the expertise and experience to handle credentialing efficiently and accurately. They can complete the process faster and with fewer errors than in-house staff. They can also follow up with the payers and resolve any issues or discrepancies that may arise during the process.

Improved operational efficiency and cost-effectiveness

Outsourcing credentialing services can free up the in-house staff’s time and resources to focus on other core tasks and responsibilities. It can also save money on hiring, training, and retaining additional staff or investing in software or equipment for credentialing. Outsourcing can be a more cost-effective and efficient solution than managing credentialing in-house.

Enhanced patient safety and satisfaction

By outsourcing credentialing services, the provider can ensure that they meet the standards of quality, competence, and ethics in their field. This can enhance patient safety and satisfaction, as well as the provider’s reputation and credibility. It can also increase patient loyalty and retention, as well as referrals and word-of-mouth.

Increased scalability and flexibility

Outsourcing credentialing services can help the medical practice grow and expand without compromising its internal processes or workflows. A specialized vendor can handle the increased workload and complexity of credentialing as the practice adds more providers or payers. They can also adapt to changing requirements and regulations without disrupting the practice’s operations.

Compliance with changing regulations and standards

A specialized vendor stays abreast of the latest changes and updates in credentialing requirements and regulations. They can help the provider comply with these changes and avoid penalties or audits. They can also provide guidance and support on best practices and industry standards for credentialing.

How to Choose the Right Partner for Outsourcing Credentialing Services?

Outsourcing credentialing services can be a smart decision for your medical practice, but only if you choose the right partner for your needs. Not all vendors are created equal, and you need to do your research before hiring one. Here are some tips on how to choose the right partner for outsourcing credentialing services:

Check their credentials

Make sure that the vendor has the necessary credentials, certifications, accreditations, or memberships to provide credentialing services. For example, look for vendors who are certified by the National Committee for Quality Assurance (NCQA) or accredited by the Utilization Review Accreditation Commission (URAC). These credentials indicate that the vendor meets the highest standards of quality and performance in credentialing.

Check their experience

Find out how long the vendor has been providing credentialing services and how many clients they have served. Look for vendors who have experience working with providers in your specialty, location, or size. Ask for references or testimonials from their previous or current clients and verify their satisfaction level and results.

Check their services

Find out what kind of services the vendor offers and how they match your needs. Look for vendors who offer a comprehensive range of services, such as initial credentialing, re-credentialing, payer enrollment, provider data management, primary source verification, delegated credentialing, and more. Also, look for vendors who offer customized solutions that suit your specific goals and preferences.

Check their technology

Find out what kind of technology the vendor uses to provide credentialing services and how it benefits you. Look for vendors who use advanced software or platforms that automate and streamline the credentialing process. Also, look for vendors who use secure and encrypted systems that protect your data and privacy.

Check their communication

Find out how the vendor communicates with you and the payers during the credentialing process. Look for vendors who provide regular updates and reports on the status of your credentialing applications. Also, look for vendors who are responsive and accessible to answer your questions or address your concerns.

Why Choose Atlantis RCM as Your Partner for Outsourcing Credentialing Services?

If you’re looking for a reliable, professional, and affordable partner for outsourcing credentialing services, look no further than Atlantis RCM. Atlantis RCM is a leading provider of medical billing, coding, accounting, marketing, IT, HR, and credentialing services for healthcare providers.

At Atlantis RCM, we offer:

  • Expertise: We have a team of experts who have extensive knowledge and experience in credentialing. We are certified by NCQA and accredited by URAC. We follow best practices and industry standards to ensure quality and accuracy in our work.
  • Efficiency: We use state-of-the-art technology to automate and streamline the credentialing process. We can complete the process faster and with fewer errors than in-house staff. We also follow up with payers regularly to expedite approvals.
  • Cost-effectiveness: We offer competitive pricing that fits your budget.
  • Flexibility: We offer customized solutions that match your specific needs and preferences. We can handle credentialing for any provider type, specialty, location, or size. We can also adapt to changing requirements and regulations without disrupting your operations.
  • Compliance: We stay up to date with the latest changes and updates in credentialing requirements and regulations. We help you comply with these changes and avoid penalties or audits. We also use secure and encrypted systems that protect your data and privacy.
  • Communication: We provide regular updates and reports on the status of your credentialing applications. We are also responsive and accessible to answer your questions or address your concerns.

Conclusion

Credentialing is a vital process for medical practices, but it can also be a challenging, confusing, and time-consuming one. Outsourcing credentialing services can help you overcome these challenges and enjoy many benefits, such as faster turnaround time, reduced errors, improved operational efficiency, cost-effectiveness, enhanced patient safety and satisfaction, increased scalability and flexibility, and compliance with changing regulations and standards.

However, to reap these benefits, you need to choose the right partner for your credentialing needs. Atlantis RCM is a trusted partner for outsourcing credentialing services. We have the expertise, efficiency, cost-effectiveness, flexibility, compliance, and communication skills to handle your credentialing process smoothly and successfully.

If you’re interested in outsourcing credentialing services to Atlantis RCM, contact us today for a free consultation. We’ll be happy to discuss your needs and offer you a customized solution that suits your goals and preferences. Let us take care of your credentialing so you can focus on your patients and your practice.

FAQs

What are the elements of credentialing?

The elements of credentialing typically include verifying and documenting a healthcare provider's qualifications and credentials, such as their education, training, licenses, certifications, work history, malpractice history, and references. It involves collecting and reviewing this information to ensure that the provider meets the necessary standards and requirements.

What is an example of credentialing?

An example of credentialing is when a healthcare provider goes through the process of submitting their qualifications and documentation to an insurance company or payer in order to become an affiliated provider. The payer reviews the information, conducts background checks, and grants the provider the necessary credentials to participate in their network and receive reimbursement for services.

What is system credentialing?

System credentialing refers to the process of verifying and documenting the qualifications and credentials of healthcare providers within a specific healthcare system or organization. It ensures that all providers within the system meet the established standards and requirements for practice and can provide quality care to patients.

What are the benefits of credentialing?

The benefits of credentialing include:
Ensuring that healthcare providers meet minimum standards of quality, competence, and ethics.
Protecting patients from substandard or fraudulent care.
Expanding access to a larger pool of potential patients through participation in insurance networks.
Facilitating timely and accurate reimbursement for services rendered.
Enhancing the reputation and credibility of healthcare providers.

What are credential types?

Credential types refer to the different categories or levels of credentials that healthcare providers can obtain. These can vary depending on the field of practice and may include degrees, certifications, licenses, and registrations. Examples of credential types include medical degrees (MD, DO), nursing degrees (RN, BSN), board certifications (e.g., American Board of Internal Medicine), and state licenses to practice medicine or nursing. Different credentials signify different levels of expertise and qualifications in a specific area of healthcare.