on Health Insurance and market trends
July 13, 2023
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:
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.
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:
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.
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:
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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:
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.