Provider credentialing outsourcing perspectives
For the physician networks of private practices and hospitals, and staffing agencies that support them, the credentialing process is crucial. Credentialing is all too frequently done carelessly or as an afterthought after a doctor or other advanced practice professional (APP; such as a nurse practitioner or physician assistant) contract has been signed. Actually, the two procedures—hiring a practitioner and obtaining credentials — should coincide so that the practitioner “participates” in most of the payer contracts for the system when he or she starts seeing patients, if not all of them. Sadly, cooperation is rarely achieved.
It is amazing that the credentialing process still receives so little attention from the operational side of the business given how crucial physician credentialing is to the enterprise in terms of reimbursement. The enterprise takes the risk of either appealing disallowed claims (since the provider would be “out of network”) or retaining claims and submitting them until the provider is credentialed when providers meet patients but are not credentialed. In the case of Medicare, for instance, providers are permitted to capture charges retroactively for a maximum of one (1) year before “timely filing” hurdles are met. The revenue cycle of the system is burdened needlessly by this inefficiency.
Even when everything goes perfectly, credentialing is a meticulous task that takes months to complete. To guarantee that practitioners are added to insurance panels effectively, healthcare organizations should assess their credentialing process, policies, and staff. The pros and downsides of outsourcing credentialing should be taken into account in that review. Of course, the prerequisite to outsourcing is that the business or individual you work with via an outsourced model must be genuinely great at credentialing and possess an attention to detail that exceeds speed.
Address staffing shortages and emergencies
When there is a lapse in the employment of credentialing professionals, outsourcing can be used successfully to address terminations, resignations, and employee time off. In order to maintain some semblance of continuity, the process of enrolling physicians and APPs can be stopped by outsourcing. Healthcare organizations can continue certifying providers and accelerating protocol with quality “replacement” employees, ensuring that there is no rupture in the continuity. Getting doctors on panels and onboarding new employees can be extremely difficult when a staff member who specialized in credentialing leaves without a suitable replacement, which can eventually have a negative impact on income.
Ability to scale
A good reason to outsource is to farm out credentialing to a company or vendor with the human capital capacity, established processes, and procedures to credential. Companies that specialize in credentialing or have a service line that specializes in it should bring efficiency in procedure and structure to the table because of their volume-related experience or their area of expertise in the plethora of steps that make up the certifying continuum.
Lowered labor costs
The cost of staffing might be cut either permanently or temporarily. When the carrying cost of personnel exceeds the cost to outsource, outsourcing credentialing may make financial sense. Typically labor cost savings of 30% or more can be achieved.
