When does outsourcing your credentialing make sense?
Many organizations who have taken on credentialing responsibilities find it challenging to master the process on a macro level. Ever-changing laws and standards impacting credentialing can be difficult to stay abreast of and/or implement.
One of the biggest challenges, which also has a direct impact on the revenue collection of most practices, is credentialing i.e. enrolling with the best insurance service provider. This is not really as simple as it sounds. With so many insurance providers having opened shop, it is not easy to tell which one would be the best for a particular medical practice. No wonder then that most practices prefer to outsource their credentialing services as this would mean one less thing to worry about.
Are you still indecisive about whether to outsource your medical credentialing?
Well, take a look at these pointers which will help you understand when the time is right to outsource your practice’s the credentialing process.
1. Big process
Collecting the necessary details from the patient and other stuffs are a big process which should happen flawlessly. If the billing service staff is employed to collect all these details then it is pretty hard for that single employee to take care of all such things. So it is better to connect with insurance service provider.
2. Lessen your burden
When you take a step forward by implementing software and appoint an insurance provider employee for claiming reimbursement then it becomes an easy task for everybody. Every employee will have his own work to do. The number of workforce will also be increased along with that the technology will also be implemented.
3. Experts on role
If your healthcare industry is less experienced in such insurance stuffs leaving them in experts hand can lead to no denials or rejections of claims. Experts will do their job professionally and minimize the risks of rejections in claims.
Here, you will find our Step-by-Step Physician Credentialing Process
1) Week 1 Strategy and Information Gathering
a) During the first ten days or so after signing an agreement, our team will work with you to massage your payer list and ensure all relevant payers are included.
b) In addition to the payer review, your account manager will work with you to ensure we have everything needed to submit and process your applications.
2) Weeks 2-5 Application Submission & Follow up
a) During this time we will contact all insurance companies and begin the application process. Some of them require an LOI (letter of interest) and others want you to submit a form on their website. Regardless of how they do it, we will take care of all of this.
b) Once the requests to join the network have been submitted, this is when the follow-up process starts and continues until everything has been finalized.
3) Weeks 6-9 Follow-Up & Contracting
a) During this period we will continue to follow up and should begin to see your application making it through the payers credentialing process.
b) Once your application has made it through the initial process, we will now ensure it transitions smoothly into the contracting phase.
4) Weeks 10-16 Contract Negotiations & Effective Dates
a) This is when things start to get fun. Agreements are coming in and you’re beginning to see some results. Payer agreements are reviewed and submitted to you for signature (if they don’t need to be negotiated). Once signed, these executed agreements are returned to the payer for loading. The loading process with some payers can take an additional 30-45 days.
b) Finally, we will work through your payer list and ensure we have effective dates and provider IDs for all applicable payers. We will then work with you to provide this information to your billing company or department.
Outsourcing your credentialing is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something serious really worth it? That’s really what you must ask yourself. Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days whereas most of our payers are completed in 90 days. Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.