Medical provider credentialing is a process through which healthcare facilities and insurance companies access and confirm the qualification of a provider. The process is vital as it helps maintain high standards in healthcare. Since credentialing tells us whether a provider has the necessary training or expertise to practice healing arts, it is paramount for everyone concerned to understand why credentialing is necessary. In this article, we will try to answer ‘why credentialing is Important for healthcare professionals?’
Lays Foundation of Excellent Patient Care
Provider credentialing installs confidence in patients. Knowing that the provider has been thoroughly inspected by the experts creates that bond of trust between provider and patient, laying the foundation for excellent patient care. Patients who trust their providers naturally follow their advice, from dietary plans to testing a new drug or having surgery. Without trust, patients are less likely to be open and honest with the providers about their medical histories; current concerns; signs and symptoms of a disease; and so on.
Patients who have confidence in their providers are more likely to stay with the practice and not seek a second opinion. Provider credentialing is beneficial in retaining skilled employees also. A healthcare organization with fully credentialed nurses and healthcare providers is more appealing to new physicians, PAs, LVNs, RNs, nurse practitioners, and support staff.
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Ensures Accurate Reimbursements
Every healthcare service provider needs to get credentialed to receive accurate insurance reimbursements. Big healthcare organizations up to small healthcare practices, of them, earn money through partnering with health insurance companies. After successfully credentialed with insurance companies, providers need to enter into an agreement referred to as a payer contract. Among other clauses in the payer contract, there are reimbursement clauses that determine how facilities and practitioners will be reimbursed by the insurance companies for the services they provide.
Getting the documents completed on time ensures that the new nurse or provider you’ve employed can start offering services on the first day. Provider credentialing is not something to push off. The credentialing time frame differs by state due to changes in legislation and credentialing laws. Before allowing your staff to interact with patients, private health insurance companies, Medicare and Medicaid will want confirmation from insurance credentialing services. If your medical practice cuts corners in the credentialing process, you could open up yourself and your practitioners to financial losses.
Enhances Your Practice Reputation
Almost every patient now does research and reviews your practice online before starting their treatment. With the availability of abundant information, patients have the power to research their healthcare professional before committing to them as a patient. Practice credentials are the key factor for patients to make the right selection as per their medical requirements. Medical credentialing is a simple and effective way to prove that they are perfectly qualified to perform patient care services – thus, improving the practice’s reputation.
Additionally, providers and facilities that are successfully credentialed are permitted by law to treat all patients, regardless of their insurance plans. This allows you to see more patients, further driving business to your facility and helping the whole healthcare organization prosper.
Reduce Medical Errors
When healthcare providers and practices get the required medical credentials, it contributes to the overall safety and security of the sector. With medical errors being blamed for 100,000 deaths in the United States in 2007, you can imagine the significance of medical credentialing in the year 2023. Also, patients have the right to expect their healthcare practitioners to know what they’re doing and work in a safe and approved manner. Medical errors include miscommunication; ordered prescription errors; incomplete patient medical records; overcrowded facilities; mismanaged workflow; and many more. As some of these errors are simply human errors, by properly credentialing every provider, you lower the risk of medical error as a whole.
Protects You from Lawsuits
Receiving external payer audit requests is not uncommon in medical billing. Government insurance companies like Medicare, Medicaid, and all commercial insurance companies are quite watchful about whether they had made correct payments. Credentialing every single practitioner could vital in such litigation. If there is a malpractice claim on a healthcare provider in your facility, you can help indemnify yourself and your institution from legal responsibility by proving that you verified every single one of their credentials and renewed the verification as needed. Not only will you shield yourself from liability, but you’ll also avoid costly fines related to legal disputes.
Challenges of Provider Credentialing
The key challenge of provider credentialing is that this complete process is complex and time-consuming. Every single insurance company has its own set of credentialing requirements and documentation. Providers who are busy in patient care won’t be able to dedicate that amount of time to filling out various applications and their follow-ups. Completing a thorough credentialing process for a single prospective hire can often take between three to six months or more.
With so much paperwork to gather and the various institutions to contact and request records from, weeks can go by with little progress. Adding to these concerns is the fact that practitioners need to have their credentials renewed every two years (except in Illinois, where the timetable for credential renewals is every three years). In this article, we tried our best to answer ‘why credentialing is Important for healthcare professionals?’ hope you would have found it useful.
Medical Billers and Coders (MBC) Can Assist You
Medical Billers and Coders (MBC) can take care of this headache for you and can also guide you as a provider credentialing expert. MBC is a leading medical billing company providing complete revenue cycle services. We can take over all credentialing tasks like gathering information; cross-checking information; choosing the number of insurance companies to get credentialed; application filling, application follow up and many more activities leading to successful credentialing. To be able to credential more efficiently, see more patients, grow your business, and earn a higher return, contact us at info@medicalbillersandcoders.com or 888-357-3226.
FAQs on Medical Provider Credentialing
1. What is medical provider credentialing, and why is it important?
Medical provider credentialing is the process of verifying a healthcare provider’s qualifications, including education, experience, and certifications. It ensures that the provider meets the standards set by healthcare facilities and insurance companies, ensuring patient safety, trust, and compliance with regulations.
2. How does provider credentialing impact patient care?
Credentialing builds trust between patients and providers by confirming that healthcare professionals have been thoroughly vetted. This trust leads to better patient compliance, fewer second opinions, and a stronger bond, ultimately improving overall patient care.
3. Why is credentialing essential for accurate reimbursements?
Credentialing is a prerequisite for healthcare providers to receive payments from insurance companies. Without it, providers may face delays or denials in reimbursements, affecting the financial health of the practice. It also ensures the provider complies with payer contracts.
4. How does credentialing improve a healthcare practice’s reputation?
Credentialing enhances a practice’s reputation by demonstrating that its providers are qualified and authorized to deliver patient care. Patients increasingly research healthcare professionals before committing, and having proper credentials can influence their choice positively.
5. How does provider credentialing help prevent medical errors?
Credentialing ensures that healthcare professionals are properly trained and qualified, reducing the risk of medical errors like miscommunication, incorrect prescriptions, and incomplete patient records. This contributes to a safer, more reliable healthcare system.
6. What challenges are associated with the provider credentialing process?
Provider credentialing is often time-consuming and complex, involving extensive paperwork, multiple insurance company requirements, and lengthy processing times. It can take between three to six months or more to complete, making it challenging for busy providers to manage on their own.
