A Complete Guide to Physician Credentialing

A Complete Guide to Physician Credentialing

The shortest way to running a successful office is to hire competent providers. The best way to hire the best providers is by getting physician credentialing done. Before we dive deeper into this process’ dynamics, it is essential to know that the physician credentialing process is as expensive as it is inefficient. It is expensive because this is an ongoing process, and failure to comply will negatively impact your bottom line. It is inefficient because it has been done the same way for decades. Improving this process could improve the American healthcare industry in more ways than one. Let’s understand this process in detail. What is physician credentialing? Physician credentialing, also called medical credentialing, is about organizing and verifying a doctor’s professional records. This process is one of the most critical and the most tedious processes in the American healthcare system. Healthcare organizations have a legal responsibility to verify the provider’s education, identity, experience, professional sanctions, license verifications, and malpractice history to protect patients from unqualified doctors.

When a physician applies to practice at a healthcare organization, he or she is required to complete an application and allow the credentialing entity to look into his or her professional documents. Why is physician credentialing important? Physician credentialing is an important cog in the wheel of your RCM process. The biggest reason that makes physician credentialing important is that healthcare providers can’t practice or get paid if they aren’t credentialed. The timing and accuracy of the physician credentialing process have a direct impact on your revenue. If your providers aren’t credentialed correctly, your practice won’t be reimbursed correctly. Physician credentialing is also essential for receiving in-network reimbursement from insurance providers. Delaying the physician credentialing process until the last minute or presenting incorrect information can spell cash-flow discrepancies for your practice. Is physician credentialing a one-time process? No. Physician credentialing is an ongoing process. A one-time verification or evaluation check of your providers won’t be sufficient when it comes to exceeding the expectations of your patients. Not only does credentialing ensure your patients receive the best care, but it also speeds up reimbursements. In fact, sometimes reimbursements aren’t approved if medical credentialing is not done. Here’re some of the many instances when providers must get credentialing done:

  • When starting a new practice.
  • When joining a new practice.
  • When adding new providers to the existing practice.
  • When insurance companies request updated physician information.

What are the challenges associated with the credentialing process? The healthcare industry is rapidly embracing technological innovation, yet physician credentialing is still an on-paper process. The old-fashioned credentialing process relies heavily on Excel sheets, which makes it prone to errors. These errors, combined with the age-old processes, are two of the many challenges in credentialing physicians. Consider these stats:

  • Healthcare practices spend almost $39 billion annually on regulatory compliance-related tasks, including physician credentialing. (Source)
  • Nearly 85% of physician credentialing applications to have missing information. (Source)
  • Almost 17% of providers’ working hours are spent on admin tasks. (Source)

Despite spending so much time and money on administrative tasks related to regulatory compliance, medical practices often can’t have new hires start practicing for two to three months after joining, which compounds the financial impact. Not to mention how one missing document or expired certification can cause physician credentialing delays, resulting in financial losses the practice can’t afford. How To Get Physician Credentialing Done For Your Eye Care Practice? You can either hire in-house experts or outsource the process to firms that offer physician credentialing services. Since we have already discussed the importance of medical credentialing, it is easy to understand that the process must be completed thoroughly. Any error or delay in the procedure can harm your reputation and make a dent in your revenue. Hiring a firm that offers physician credentialing services will benefit your practice in the following ways:

  • Thorough knowledge of the end-to-end process.
  • Teams are up-to-date with regulatory requirements when doing background checks.
  • Cost-effective and faster processes.
  • Streamlined approach.

Conclusion The physician credentialing process is an important one that’s here to stay. At Alta Medical Management, we have decades of experience providing physician credentialing services to eye care clinics and providers. With cloud-based credentialing solutions, trained experts, and a streamlined approach, we are positioned to help you increase revenue through faster processes and approved claims. Are you looking for some help with physician credentialing? Contact us!