Medical credentialing is vital for the healthcare industry. It enables facilities to provide undivided attention and care to the patients. Clearly, without medical credentialing, barely any hospital would be able to perform to its true potential.
As much as it is important for the healthcare industry, it is equally costly and time-consuming. If done correctly, it can double the revenue. Otherwise, it can cause major losses for a healthcare organization. With a per-hour rate of $100, it costs $20,000 per year to medical facilities and even more if other support work is added. Several medical credentialing companies now exist to save the facilities from exorbitant expenses.
Below we have provided you with a comprehensive overview of medical credentialing services costs as well as provide ways to save on it to boost revenue.
What is medical credentialing?
Before you may ask, medical credentialing is a process that involves the verification of the qualifications of the medical staff to ensure their legitimacy. In layman’s terms, you can consider it similar to background checks.
During this process, an applicant’s degree/certification is submitted to the institute that originally provided it to confirm its authenticity. Once the approval comes from their institute, the candidates become eligible to perform in their position.
A medical credentialing specialist’s job is extremely critical. If it is not done properly, it will not only cost patients their lives but also jeopardize the entire organization. Therefore, hiring a skilled or expert medical credentialing specialist is important for healthcare companies if they wish to thrive in the industry.
Cost of Medical credentialing of physicians:
Now that we are aware of the importance of medical credentialing in the healthcare industry let’s figure out how much it costs. Several factors can influence the cost of credentialing, including the size of your facility or how many physicians you add to your team.
Another great factor affecting the cost of credentialing is the method you choose to carry out the process. But before we learn how to save cost on credentialing, first find out the credentialing costs for physicians.
- Individual Physician Credentialing:
On average, an individual physician credentialing costs somewhere around $100 – $200, which can vary depending on the service provider. Recredentialing for physicians costs almost the same. While most facilities have a re-credentialing period with a two-year gap, some may extend it by a year or two.
- CAQH Database:
CAQH Proview, earlier known as CAQH Universal Provider Datasource, is a provider data collection online solution that helps eliminate data redundancy during information collection to improve the credentialing process. Initially, it costs around $200 – $500 to set it up. However, you will break even in a short time once it begins to improve the credentialing process.
Management costs vary depending on the involvement level required to make changes to the database. A basic database management job costs $50 to $100 per month, which is quite reasonable compared to the benefits it offers.
- Insurance Panel Application:
Each insurance panel application can cost around $100 and even double this in some cases.
Outsourcing Credentialing Services:
Considering the amount and time consumed in the credentialing process, your organization can opt to get outside help by outsourcing the entire process. Although it is not something new, many healthcare organizations previously saved a lot on time and money by outsourcing their credentialing processes to expert providers.
For instance, you can contract with medical credentialing companies like Sybrid MD, Medical Liens, etc., who will assign tasks to the respective field experts to provide optimal results.
That said, outsourcing companies will let you access only limited information, which is obviously not enough to prepare and maintain records for the review of key stakeholders. Besides that, you also need to keep track of your files for storage purposes, as these companies don’t offer that privilege as well. You need to have a strict check on re-credentialing deadlines as well.
Perks of Outsourcing Medical Credentialing Services:
While there are many benefits to outsourcing credentialing services, we have listed the top three benefits of outsourcing below. Let’s check them out!
- Cut Administrative Cost:
It is quite implicit no matter how big your staff is, human error can always be expected in every task performed by a resource. Not just it affects your business process but affects the overall efficiency of your organization. Why spend so much time and money on administrative tasks when all of that can be automated? Installing the right technology speed up the credentialing process by enabling you to access extensive databases in a short time. Many hospitals fail to scale up their services due to their inability to keep pace with medical credentialing requirements.
- Expedite Revenue Cycle Management:
Insurance only pays healthcare providers who have accurate credentialing services. If any administrative errors are caught in the process, the insurance providers may deny paying for the rendered services. That means more time is wasted in re-credentialing to revise the work. In-house medical re-credentialing takes up to 180 days, while outsourcing can reduce the time window to 90 days.
- Improves Data Management:
Medical credentialing software provides you access to a single integrated system that not just performs credentialing but also tracks providers’ applications, and monitors and stores documentation to run the business processes smoothly.
Outsourcing credentialing to the experts minimizes the risk of non-compliance, improves the redundancy rate, boosts productivity, and frees up resources for other important tasks.
Conclusion:
In general, medical credentialing services cost $2000 to $3000 per year only for physicians. If other support works, including taxes, are added, the cost can go up even further. In-house credentialing tasks can soak up your time and energy. Therefore, looking for the best medical credentialing companies in your state is recommended if you plan to scale up your business and increase revenue. These companies will not only perform credentialing for you but expedite your RCM (Revenue Cycle Management) and improve data management.