5 Reasons Why You Should Outsource Your Medical Credentialing

Credentialing in healthcare is the process through which medical organizations evaluate healthcare practitioners’ credentials to ensure they have the necessary valid licenses, qualifications, and expertise to deliver care to the members enrolled in insurance plans.

This procedure assesses whether a healthcare professional is qualified to execute the activities for which they are being considered at a facility and/or under the health plan of an insurance company.

Practitioners are credentialed once their credentials have been verified by the payers; that is, the health insurer validates that the practitioner’s qualifications, education, training affiliations, and license for the first time and then every 3 years.

Practolytics’ outsourced credentialing services offer high-tech solutions that save time for your team and eliminate potential errors in your operations.

How are medical staff credentials and privileges managed?

The process of credentialing and privileging is complicated, time-consuming, and detail-oriented. This time-consuming procedure involves much diligence, attentiveness, follow-up, and monitoring.

Let’s go through how the procedure works: 

1. It is the applicant’s duty to be truthful throughout the application process. However, it is the healthcare institution’s job to assure accuracy in practitioner’s qualifications, education, training affiliations etc.
2. Performing Primary Source Verification (PSV) on every info given: The act of getting licensure and certification information is referred to as PSV. It can be done directly from the source that gave the credentials or indirectly through a secondary source who has been granted the authority to verify that credentials.

What are the primary reasons why you should outsource your medical credentialing?

Outsourcing credentialing provides a high-tech solution that reduces oversights and errors that are frequently generated by outmoded manual credentialing methods.

1. Boost ROI

Did you know that credentialing may cost a facility up to $20,000 per applicant every year? Healthcare firms may significantly minimize these expenses, paperwork, and the requirement for manual or extra labor by outsourcing the whole process to a credentialing partner allowing them to divert their valuable resources to more vital aspects of the business.

Outsourcing to a technology-enabled credentialing partner rather than in-house credentialing may save clinics 20% to 80% on expenditures. Healthcare firms can cut overall expenses, focus on company growth, and generate higher Returns On Investment (ROI) if they spend less time on credentialing and onboarding.

2. Eliminate Human Errors

Credentialing presents several obstacles and hardships, which are exacerbated when an organization’s in-house credentialing procedure is performed manually. Because credentialing necessitates regular fact-checking on a variety of qualifications, degrees, and papers per application, it is easy for the resources of the organizations to become overloaded and result in errors.

The manual method of credentialing might result in a plethora of human oversights that can have a damaging influence on the overall process and your organization. It just takes one misspelling, one wrong call, or one misplaced document to erroneously reject a qualified candidate or give an offer to an ineligible one.  Having the presence of qualified employees and automated technologies, outsourcing a credentialing partner can decrease the number of mistakes that are prevalent with manual credentialing.

3. Ensure Compliance

Hospitals, clinics, agencies, and other local healthcare institutions frequently collaborate with a range of providers. However, because each institution has a unique set of criteria, keeping track of everything in-house and ensuring compliance becomes more challenging. Even one criteria ignored, not satisfied, or improperly validated can have major ramifications for both the applicant and the organization. Candidates may lose their license and their job, and corporations may face litigation and liability claims. In addition to the complications, applicants may be required to re-attest their credentials every 90 days, which is a requirement under payer credentialing.

Outsourcing to a credentialing partner will assist you in navigating each payer’s changing requirements allowing your applicant to get certified appropriately and begin collecting payments on schedule.

4. Increase turnaround times

Traditionally, it might take healthcare organizations up to 120 days to verify and assess an applicant’s qualifications in-house. The procedure might become much lengthier if you interact with many providers owing to all the varied compliance standards. This means more work for your team and more money spent.

Outsourcing to a credentialing partner can help you dramatically increase turnaround times, both for projects and onboarding. An outsourced credentialing partner may certify your applicants in as little as 10-15 days, with the correct automated credentialing system in place. 

5. Improve Efficiency

It is not surprising that many healthcare organizations have disorganized and inefficient processes. With so many divisions and unforeseen events at every turn, things may quickly become chaotic – especially when spreadsheets, papers, and documents that must be updated on a regular basis are dispersed across several teams in multiple formats. The lack of structure, along with the frequent need for changes, will result in a significant amount of effort wasted simply attempting to make sense of your records.

An outsourced credentialing partner will handle all of this documentation, saving your staff a significant amount of time and effort. The correct partner will assist you with checking, verifying, updating, and revising all files to ensure that everything is up to date. Your team’s efficiency and production will improve after credentialing is handled.

Final Thoughts

In-house credentialing is a time-consuming and labor-intensive procedure that drains your company’s resources, time, and revenue. If adequate processes are not implemented, your business’s efficiency and productivity will suffer.

Seeking a credentialing partner, would allow healthcare organizations to prevent these negative consequences and would help them better manage their applicants and data. Organizations that can outsource credentialing to a partner can expect to minimize overall expenses, optimize onboarding efforts, and assure compliance.

Practolytics help relieve the strain on your healthcare organization by handling the credentialing process from beginning to end. Do you want to know more? Please contact us at [email protected] (or) +(803) 932-9624

ALSO READ – Top Mistakes in Credentialing Process that Cause Revenue Loss for Medical Practices