In our years in the medical billing industry, we’ve seen how credentialing can become a major problem area for our clients. We have one client whose new physician started seeing patients before being credentialed and approved by the payers — his services ended up being free — it was bad news all around. The practice lost money and the physician lost production compensation.
Practitioners sometimes get (understandably) overwhelmed by the credentialing process, or find out after completing their initial submission that their approval just isn’t coming as fast as they need. To avoid a protracted approval process or a denial, it is important to understand the complexity of submitting a successful credentialing application, and consider letting a credentialing professional handle the job — it will save you time and money, and let you keep taking care of the patients who need you instead of worrying about reimbursement.
Thoroughly Documenting Your Practice
Thoroughness is crucial to a successful initial credentialing submission. It is laborious and requires everyone involved to be knowledgeable about the application process and committed to your goal of a successful submission. Often, a lack of thoroughness is because providers do not always know exactly what the insurance companies are looking for. At Physician Revenue Navigators (PRN), we know what a successful submission looks like, and our staff can devote a level of undivided attention to the process that you cannot strive for with your own staff, who already have a lot on their plate with daily operations.
A thorough and successful credentialing submission requires a complete picture of the history and current state of you and your practice, including:
- Employment history
- Education and certification documentation
- Information about the types of patients you see
- Legal history and current status of your practice
- Proof of licensure
- Proof of liability insurance
- Thorough documentation of your contact information
- Up-to-date clinical privilege forms
If any of these areas are inaccurate or incomplete, it can either lead to huge delays, a vastly protracted approval process, or even the denial of your submission. That is why it is important to have the entire staff on board with your credentialing, even if it is being handled by your billing company. PRN offers training for your staff so that you have proper practices in place to secure adequate documentation of your practice and meet credentialing standards.
Engaging the Whole Team
We consider education to be an important part of our role as revenue cycle managers. We will often go in and do staff training for our clients. Before the patient even walks in the door, your staff members need to know how to handle the patients’ paperwork and keep all transactions appropriately documented for your credentialing submission. If your office plans to handle its own medical credentialing, we can help you develop an effective set of processes to handle applications, and even consider the possibility of implementing credentialing software into your workflow. However, considering the amount of time and effort it takes for your staff to handle credentialing on top of their regular workload, we do recommend outsourcing it to a professional.
Following Up Regularly With Insurers
With credentialing, the squeaky wheel often gets the grease — checking up regularly can shorten the waiting time between credentialing phases, and it can also keep you in the loop as to the status of your application. This process can take months, and often, healthcare practitioners are (understandably) more preoccupied during this time with taking care of their patients than pulling on the sleeve of the insurance company to check on their application.
Throughout the application process, you also need to know the ins and outs of both public and private insurer’s different approval processes and be able to meet each insurer’s individual set of regulations and requirements. It takes a level of experience that you do not have unless credentialing is something you do full time. PRN has an accrued base of knowledge about what works for different companies, and our staff is fully devoted to navigating each phase of the approval process with diligence and attentiveness to detail.
Save Time and Money by Outsourcing Your Credentialing
It is possible for healthcare providers to do their own credentialing, but the real question is, “Is it a smart business idea?” It is like your IT system — you would not want to perform your own server upgrade because if you do it wrong, you are going to risk losing productivity, turning away patients, and then asking a professional to fix it. Your credentialing submission is the same way; if it does not go as planned, you end up not getting paid, wasting your staff’s time, and seeking out a credentialing professional to help you do it successfully. You can save your practice time and money by outsourcing from the get-go. It’s a win-win for you and your patients when you have an effective affiliation with insurers to get reimbursed.
Physician Revenue Navigators partners with healthcare practitioners to get their office properly credentialed and keep their revenue cycle moving. We support healthcare organizations of all different practice types in all aspects of a healthy revenue lifecycle. Contact us to learn more about how we can assist your organization.