Whether you appoint a new doctor or start a new medical practice, you need to know about the credentialing process before starting up or establishing. If you do not know the credentialing services and strategy, it will delay the cash flow. Moreover, it will cause difficulty in scheduling because of the restriction of patients and access to phone calls from the payers.
What is credentialing in healthcare?
Physician credentialing is the process of obtaining, verifying, and assessing a physician’s education or qualification who will provide the medical services. Credentials are the documents, evidence of a license, education, training, and experience of the medical practitioners. In short, it is all the documentation and verification of the medical physicians.
Credentialing will also investigate the provider’s background and financial history, references, and criminal records. It is a time- consuming long process that needs to prepare early. The medical credentialing services is also called physician credentialing, medical credentialing, or doctor credentialing.
Some Specific tips need to understand, and they are as follows:
- Assign a Credentialing Coordinator
Assign a coordinator whether you outsource your medical billing services or you prefer in-house medical billing specialist. They take care of the expiration of the time and deadlines of the medical business. Additionally, they also update about the new trends and future trends. Assigning a credentialing coordinator will remind you to be on time so that credentialing services won’t be late and will not deny the reimbursements.
- Allow Plenty of Time for the Credentialing Process
Credentialing allows the medical specialists plenty of time for the credentialing process. Usually, the time duration of the claim submission is 90 days, but the innovative practices give hopefully less than 90 to 150 days to complete the process.
- Stay Updated with the Coalition for Affordable Quality Healthcare’s Credentialing Program
It is a worthy program for the physicians who regularly attest and re-attest their documentation by the Coalition for Affordable Quality Healthcare (CAQH). These physicians are more likely more efficient, credentialed, experienced and trustworthy for the medical practices and services. Payers can check out and adopt this program for credentialing.
- Link a New Provider’s Start Date to Submission of Credentialing Forms
Many medical practices demand credentialing paperwork when there is an employment offer. But still, others will include the new physician for the starting date for the paperwork submission. You cannot make a new physician starting date less than 120 days after receiving their credentialing information.
- Create a Sustainable Credentialing Process
Making a credentialing work process can be tricky, yet it helps over a long period. Even when outsourcing the credentialing system, your work process should keep up with every necessary configuration, documents, and report. With a multi-doctor practice, it appears that re-credentialing is significant and helps the medical apprenticeship extraordinarily.
- Don’t Assume All Payers Allow Billing a New Physician as Locum Tenens
A locum, or locum tenens, is an individual who temporarily fulfills another physician’s duties. It is a term that is mainly used for a doctor.
Instead of another physician whose credentialing is not finished, you can be in charge by assigning them as locum tenens (fundamentally a fill-in doctor). However, not all payers let you do this, and it is ideal for getting the doctor completely credentialed so you can charge regularly. However, assuming that you can’t, essentially contact payers to gain proficiency with their strategy on locum tenens billing.
- All Physicians should up to date their Contact Information
Ensure that your credentialing officer or manager keeps up-to-date and complete information of all the physicians. It might be time-consuming without direct interaction with the physicians regarding the credentialing or re-credentialing issues. In addition, the credentialing process involves essential communication and submission of multiple forms.
- Make Sure All Physicians Understand their responsibilities
Every provider should know about their responsibilities in terms of re-credentialing or credentialing. When employment is offered, there is specific information that payers should know. They need detailed information such as license, documents, certifications, education history, financial background, experiences, and much more for comparison with other physicians.
- Conduct Your Background Check Early in the Process
In the early stage, conduct your background check because it is time-consuming. It includes the checking, verification, training, license, work history, financial background, and education past. It is the comparison to check with new hiring and other suitable employees for the medical specialist designation.
- Thoroughly Understand the rules and regulations of your state
You should know the laws and regulations of your state for physician credentialing. These rules and regulations can be based on other states’ organizations or payers. The payer may streamline the credentialing for the new job if a physician is credentialed with a payer in one state before moving to another.
Try to remain updated with the agreements and laws of your state because it can create problems in your workflows and cash flow. So, it is essential to understand the rules and agreements of your state.
Why is credentialing so important?
Credentialing is very significant for the patient’s trust, and the procedure gives patients confidence to place their trust in choosing their healthcare providers. It is one of the essential steps to increase trust in medical practices.
What are medical credentialing services?
Medical credentialing services are the authoritative source of verification and checking for most credentialing and insurance companies in the United States.
What are the three primary phases of provider credentialing?
The three primary phases of provider credentialing are as follows:
- 1. Gather Information
- 2. Check the Information
- 3. Award the Provider with Credentials
Top benefits of outsourcing provider credentialing
- It reduces operating costs (typically be around 30-40%)
Operating costs are usually composed of many segments of operating expenses, including:
- Salary and wage expenses
- Accounting and legal fees
- Bank charges
- Sales and Marketing costs
- Rent
- Advertising
- Travel expenses
- Repair and maintenance costs
- Utilities
- Salary and wage expenses
- Entertainment costs
- Office supply costs
Operating costs are also part of the cost of goods traded, the expenses directly related to producing services and goods. Some of them are:
- Direct labor
- Direct material costs
- Rent of the plant or production facility
- Benefits and wages for the production laborers
- Repair costs of equipment and machine (if applicable)
- Taxes of the production facilities
- 2. Gives you the advantage of getting experts in your medical staff
- 3. Allows your staff to focus on medical billing and collection of payments
- 4. It gives you more time to grow your practice and concentrate on your patients
- 5. Reduces the amount of paperwork drastically
- 6. Eliminates hours of frustration
Remember, the process of provider credentialing and payer enrollment is essential to remain monetarily doable. However, your first and foremost priority should be to treat patients, which is your medical business’s core competency. Moreover, you should outsource your medical credentialing services to concentrate on your patients and provide the best quality care.
Why is Outsourcing Credentialing Important?
Credentialing has been an enormous headache for all medical practices, paying little attention to the size and specialty. It requires a great deal of time and exertion. Likewise, it is a complex and confounded process that frequently is the cause of low revenue cycles. Such gaps comprise the inability to gather Medicare Payments, loss of income, and deficient revenue cycle performance. Outsourcing your credentialing processes might be the best answer for plug-in those problems.
Here are some points of the motivation behind that why credentialing outsourcing is better:
- Top-quality end-to-end credentialing process management.
- Expect less to zero mistakes in your credentialing process.
- Increase in revenue.
- Expect precision and accuracy.
- You can expect detailed and time reports whenever you need to review their performance.
How Can UControl Billing Help You?
UControl Billing is an outsourcing medical services company with a wide array of medical billing services that can make your day-to-day tasks endurable and less frustrating. UControl Billing understands that dealing with credentialing is a massive headache. So, they help you, and they offer credentialing services that will provide you and your staff members with much-needed relief.
Partnering up with experts is never a bad idea. You can schedule a free consultation with UControl Billing today if you want. To learn more about UControl Billing and how they can help you with your provider credentialing burden, schedule an appointment with their medical credentialing specialists today! Contact them.
