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When does outsourcing your credentialing make sense?

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When does outsourcing your credentialing make sense?


Credentialing, defined as primary source verification of an applicant is who they say they are, have the education they state they do, and are free from various state, federal, or other sanctions, is highly regulated in the health care industry by federal law, accreditation standards, risk management practices and organizational policies.

The prime function of medical practices is to address the issues of their patients and offer them the best treatment and care at any hour. This prompt functioning of the practices has actually improved the healthcare situation. However, when it comes to running a successful medical practice, things still seem to be a bit bleak. This is because of the various challenges that are faced by these practices, irrespective of their area of expertise or their size.

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 rife to outsource your practice’s the credentialing process.

1. Busy Staff:

The process of collecting all the essential details from the patients is quite a strenuous task and a complicated one at that. If your staff seems to be always busy in this process, this could mean that it does not have enough time to concentrate on other important matters. This can have a direct impact on the productivity of the medical practice. Outsourcing the provider credentialing process would leave out more time for your staff to concentrate on other issues.

2. Increased Efficiency:

Efficiency is key within every industry and healthcare is no exception. If you’ve been running a practice for any length of time, you know that the credentialing and enrollment process often feels like you’re walking in a maze with a blindfold on. Credentialing professionals get out of this maze by relying on advanced technology and payer relationships.

3. More Burden on Employees:

If the employees of your practice seem to be overburdened with responsibilities due to the credentialing process, this could actually affect their efficiency. This is surely not good news for your practice. In such cases, outsourcing the process to a professional credentialing service would surely ease out the burden. What’s more the agency will bring with it new software that will actually simplify the whole process thus leaving the employees with more time to improve the services.

4. Lack of Expertise:

In case, you have newly setup a medical practice, chances are that you are not really well aware of the best insurance providers in the arena. You may also be unaware of the various regulations and conditions that have been laid down by the federation. In such a scenario, outsourcing your credentialing process would ensure that your practice does not lose out on revenues due to lack of expertise and know how.

5. Impact on Service:

Is the whole credentialing process impacting the quality of service of your medical practice? Remember that the popularity of a practice depends upon its services and if the official work is actually keeping the staff members from offering the required help and service, this is surely not good. What you need is to outsource the credentialing to an outside agency such that your staff has ample time left to interact with the patients and offer them the best service. After all, this is what will prompt them to come back again when they need any medical help.

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.  Are you certain that your current credentialing needs are being handled efficiently or being done incorrectly by someone who lacks proper training or experience?  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 daysIs 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.

By outsourcing the credentialing process of your medical practice, you are sure to reap many benefits like happier patients, increased revenues, timely collections and what not. So, stop thinking & Go ahead.

Contact us for credentialing service today for your medical practice.

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