How is Practice Revenue Related to Physician Credentialing?

Credentialing is an important aspect of the revenue cycle process within which the medical experience and expertise of a provider is verified. If the provider is not credentialed with commercial or government payers, it can lead to loss of revenue as claims will either get delayed or denied.

This procedure is quite voluminous due to varied payers requirements that tend to change over time. Due to this, it becomes necessary for practices to keep up with the requirements because proper credentialing is necessary for establishing claims reimbursement for a given payer.

Things to Know:

How Lack of Credentialing Affects Revenue and Patient Care?

If you wish to hire a physician who either belongs to another practice or is just out of residency program, you will have to deal with various MCOs (managed care organizations) so that the physician gets credentialed. It can take either 30 days or a year for the MCOs to verify the documentation before you can add the physician to your panel.

Till the credentialing process is not complete, the new physician can’t treat patients or get paid for treatment. Due to this, the ability of the new physician to generate revenue for the practice gets restricted.

Why is Credentialing Often Ignored?

Due to the burdens of managing a healthcare business, physicians tend to forget about credentialing which happens to be an important area of practice management. This procedure is becoming daunting for physicians as well as hospital administrators as they are left with less or no time to meet state, federal and payer requirements around reimbursements.

In this process, a wide range of important documents are acquired from providers and reviewed. It also requires the verification of background information to ensure that the document is accurate and in compliance with established payers’ standards for participation.

Practices and hospitals find it to be a tedious task because they need to make sure that they have the required resources for handling the on-boarding of physicians when they join a hospital or practice. It takes around six to nine months for a physician to get credentialed with the government or commercial payers.

MBC Helping Practices Reduce the Credentialing Delay

With the help of a dedicated credentialing department, MBC manages this often overlooked requirement in a timely manner for its clients.

From provision of end-to-end credentialing, re-credentialing solutions and primary source verification to ensuring 100% quality assurance, MBC provides professional credentialing support to many practices and hospitals across the US.

By partnering with MBC, practices have been able to alleviate the burden of this procedure and get paid on time.

FAQs

1. Why is credentialing important in the medical revenue cycle?
Credentialing ensures that a provider is verified by payers, allowing them to receive reimbursements without delays or denials.

2. How long does the credentialing process usually take?
Credentialing can take anywhere from 30 days to 6–9 months, depending on the payer and completeness of documentation.

3. What happens if a physician isn’t credentialed?
Uncredentialed physicians cannot treat patients or receive payments, leading to loss of revenue and delayed patient care services.

4. Why do healthcare practices often delay credentialing?
Due to time constraints and administrative burdens, credentialing is often overlooked despite being critical to practice revenue.

5. How can MBC help with the credentialing process?
MBC offers end-to-end credentialing services, including re-credentialing, primary source verification, and payer compliance, to ensure timely reimbursements.