Physicians/providers are revenue-generating members of hospitals or healthcare organizations. Credentialing enables practitioners to become employable as they can treat patients.
Today as health systems are growing continuously, and more and more providers need to being credentialed with insurance carriers to realize exponential revenue growth. But first, we need to understand what is credentialing?
The process of Credentialing
The process of credentialing simply validates that a physician or practitioner meets certain standards for delivering clinical care. In the initial aggregation process, the payer will ensure that all forms have been properly completed by the practitioner. Before that, the provider needs to send its credentialing application and required supplemental documentation to the payer.
In the second stage, if a discrepancy is discovered, which means supporting documents are missing or the application is incomplete, the payer has the right to (and in many cases will) return the application with all supplemental documents back to the provider and provider need to start the application process from scratch. It is observed that the whole credentialing process will take anywhere from 3 to 6 months.
Credentialing process can be frustrating if you are not familiar with the process, especially with provider turnover in the urgent care setting. Practitioners need credential advanced care practitioners (ACPs), chiropractors, and therapists including behavior health specialists depend on a requirement of a specific insurance company or network (payer).
Payer-Specific Requirements
Payer has its specific requirements that practitioners need to know and understand. Moreover, insurance companies have the right to change the process at will without being notified. Generally, a change in process is discovered only when you try to credential your next new practitioner.
Exponential growth in Revenue due to Credentialing
Medical credentialing is beneficial for Practitioners because they get privileges to accept clients from insurance companies. Moreover, they can expand their patients who have access to them. In the process of credentialing even patients enjoys the greatest benefit of all, the knowledge that the medical industry is maintaining rigorous standards to ensure the highest quality treatment.
Hospital systems are missing out on potential revenue due to practitioners’ are not credentialed which results in an inability to see patients.
Average primary care physician can amount to more than $30,000 in lost revenue due a one-month’s delay in credentialing for the month. Moreover, this lost revenue opportunity increases substantially for higher-billing specialties such as orthopedics and cardiothoracic surgery
It is possible to capture every dollar with the right provider enrollment strategy but also proper tools are needed to identify the financial risk in-process provider enrollment applications.
Apart from various benefits of credentialing of practitioners, credentialing and enrollment can pose major operational challenges for a hospital system. Let’s understand how?
Credentialing and enrollment can pose major operational challenges
The credentialing process poses major operational challenges to hospitals such as delays in getting new clinical staff on board and reimbursed for patient care for hospitals. Causes of significant delays in getting new clinical staff on board and reimbursed for patient care are disparate requirements of payers, inefficient, paper-based communication, duplicative processes, and applications. This significant delays affect hospitals’ revenue cycle performance including delayed payments, greater days in accounts receivable, and even increased write-offs.
We at Medical Billers and Coders (MBC) offer various Credentialing and Enrollment Services to support physicians and can help you to grow your revenue exponentially by Getting Credentialed for More Insurance Companies.
FAQs:
Q: What is medical credentialing, and why is it important?
A: Medical credentialing is the process of verifying a physician’s or healthcare provider’s qualifications, licenses, and professional history to ensure they meet the standards required for clinical care. It is crucial because it allows providers to accept patients from insurance carriers, enhances patient trust, and ensures compliance with healthcare standards.
Q: How long does the credentialing process take?
A: The credentialing process typically takes between 3 to 6 months, depending on the payer’s requirements and the completeness of the submitted application.
Q: What happens if there are errors or missing documents in the credentialing application?
A: If discrepancies or missing documents are identified in the credentialing application, the payer will often return the application for correction. In many cases, the process must start from scratch, which can significantly delay the credentialing timeline.
Q: How does credentialing impact hospital revenue?
A: Delays in credentialing can lead to significant revenue losses. For instance, a one-month delay for a primary care physician can result in over $30,000 in lost revenue. The losses are even greater for higher-billing specialties like orthopedics and cardiothoracic surgery.
Q: How can Medical Billers and Coders (MBC) help with credentialing?
A: MBC offers comprehensive credentialing and enrollment services to streamline the process, reduce delays, and ensure providers get credentialed with more insurance companies. This helps maximize revenue and minimize operational challenges for healthcare organizations.
