If you are a practice that wishes to contract with third-party payers, then it is necessary that you attest to the qualifications and competencies of your physicians. This needs to be done through a process of source verification, data collection and committee review. If the physicians are not credentialed properly by an insurance company, then they won’t get paid on time for treatment of patients that are covered by that plan. This will result in a direct hit to the revenue cycle of your practice. Even if the physicians see the patients, the patients will be charged a higher deductible or out-of-network copay, which will be hard to collect because eventually, a great deal winds up in collections.
Provider credentialing is a critical process for ensuring quality care and strengthening the practice’s financial health but such legwork also creates administrative burden. From source verification and certifications to experience, training, residency and licenses, there are various factors that need to be verified. The higher a physician performs in relation to these factors, the higher his/her credentialing will be.
It is necessary to ensure that credentialing is done properly or else your practice will run the risk of not getting paid. Also, it is important to note that this is an on-going process and just a one time verification won’t be sufficient. Every time a physician joins or leaves your practice, you will have to conduct this process.
Considering the complexities and paperwork involved, many practices prefer to outsource this labor-intensive process to a third party. Most reputed medical billing companies offer this service to practices across the US. They take away the hassles of paperwork involved in credentialing and reduce the burden for practices.
Outsourcing this service has helped many practices become more profitable. It helps increase the efficiency of the practice because a dedicated team will be handling the credentialing process which feels like walking in a maze with blindfold on. Billing companies have credentialing professionals who make use of advanced technology and payer relationships to get practices out of this maze.
Outsourcing helps reduce labor costs and also eliminates the risk of turnover. You don’t have to worry about your practice’s credentialing needs getting displaced to the bottom of the stack. Having a reliable billing partner will help you avoid hiccups in the cash flow for your practice.