Why Outsource Credentialing in 2020?
on Monday, January 6, 2020
There are many reasons to outsource credentialing this year. Below are just a few of the benefits of choosing a credentialing services provider to manage the process for you.
Outsource Credentialing to Ensure Credentialing Compliance
Credentialing can become “out of sight, out of mind” following completion of the initial credentialing process.
However, the credentialing life cycle of a practice includes maintenance of provider credentials. Monitoring CE credits, expiring certifications, licenses, and insurance is a detailed task and without a dedicated credentialing team of experts, opportunities for human error are significant.
Re-credentialing or re-validation with commercial and government payors is also a part of the credentialing life cycle. Payors will re-credential or re-validate a provider every 2 to 3 years. Failure to complete re-credentialing or re-validation will result in claim denials and lost revenue.
Outsource Credentialing to Prevent Claim Denials
Credentialing directly affects the cash flow of a practice. Yet, many practices do not think about credentialing until something triggers there is a credentialing-related issue.
A BIG trigger occurs when a claim is denied or reimbursement is lower than anticipated. If the issue is not due to how the claim was filed, then the reason may be related to provider credentialing.
For example, a provider may not have completed re-credentialing or may not be participating in the plan in which the patient is enrolled. Non-credentialed or non-paneled providers do not receive any reimbursement for their services from plans with no out-of-network benefits (e.g. HMO plans).
Lower-than-expected claim reimbursement can also be attributed to the out-of-network benefits the patient’s plan offers. PPO plans, for instance, have out-of-network benefits with higher deductibles, co-pays, and lower co-insurance levels.
Every practice needs an experienced team solely committed to credentialing maintenance so that nothing slips through the cracks. Outsourcing with the CredentialingOne team yields the additional advantage of innovative technology that monitors credentialing compliance and automatically alerts you to pending expirations.
Outsource Credentialing to Save Time & Resources
A provider may see 25 to 35 patients (or more, depending on the practice) on an average day. Providing medical treatment is a full-time job; but making sure the practice is profitable is also both essential and time-consuming. This is the main reason practices outsource services to experts in various industries.
CredentialingOne’s expert staff and technology complete all credentialing documentation, track applications through fulfillment, and follow up when necessary. With CredentialingOne you can maximize cash flow by preventing claim denials and other credentialing issues and do so without sacrificing time and attention away from patient care.
Providers are in the business of healing – providing comfort and compassion to patients and their family and friends. Most chose this profession for their passion for helping others, not for the extensive administrative work and time that the credentialing process requires.