Why does outsourcing credentialing make sense?

The number one goal of any healthcare practice is to provide the best medical care for as many patients as possible. As technology has advanced, so has the ability to deliver the highest quality care. But as medical imaging, life-saving medications, and state-of-the-art equipment have advanced, so have bureaucratic paperwork, systems management, and a whole host of new administrative roadblocks.

These roadblocks often prevent healthcare practices from focusing on patient care. Among these roadblocks, physician credentialing and insurance enrollment are fast becoming the most complex and confusing. Because of the complexity of the insurance credentialing processes, it is usually smart for practices to outsource their credentialing, as this frees up a lot of time and energy for practitioners to concentrate on what they do best.

It makes sense to outsource because the process is specialized and ever-changing. 

Each insurer has its own process, and it is common for insurers to change their rules and requirements frequently. As a result, if a practice does not outsource its credentialing procedures, its internal staff will have to stay up to date with various shifting standards. This is time-consuming and often frustrating, as what was the correct paperwork last month may not be the correct paperwork this month.

And the more complex the practice, the more complex the credentialing process. For example, if a practice has multiple doctors or multiple locations, that increases its insurance needs—and its credentialing paperwork.

It makes sense because outsourcing will make a practice more efficient.

Apart from all the shifting requirements, the credentialing process often has many steps that can take a long time and require a lot of independent follow-ups. A new requirement for credentialing can also be triggered by any slight change, such as an upgrade to the management system, a new doctor, or even a new set of medical procedures. Internal staff members already have a million other things to do–often more pressing–so why add the burden of taking the initiative to stay on top of all these time-consuming credentialing steps?

Further, insurers often drop a practice’s application without notifying anyone. Independently keeping track of credentialing applications is essential to maintaining progress. Again, this requires multiple follow-ups. Outsourcing credentialing ensures that a practice has a dedicated person who will follow through on its behalf. This is vital as an outsourced person will not only be up to date on the latest standards but will also be able to tirelessly advocate for the practice.

It makes sense because outsourcing increases profits and decreases risk.

Outsourcing credentialing can save a healthcare practice money by reducing labor costs, unwanted risks, and unnecessary fees. When credentialing is outsourced, a practice only pays for services as needed and can easily avoid the little mistakes that lead to massive fees. This is crucial because undiscovered mistakes can also lead to future lawsuits and malpractice investigations. Credentialing in-house not only leaves a practice at risk of insurmountable fees but also of massive damage to its reputation due to unknown credentialing requirements.

Additionally, healthcare practices and insurers usually have to exchange several emails and calls during the credentialing process. This can create uncertain timelines. Forgetting to follow-up on time will lead to more delays and extra fees. In some cases, if a delay is not addressed, the entire process may have to be restarted. Outsourcing can solve these issues by providing each practice with a designated person to manage every step of the application process. This means fewer errors, fewer delays, and more money saved.

It makes sense because outsourcing ensures that no institutional knowledge is lost.

There is already a limited labor pool to hire from, and people quit every day. If the internal staff member handling credentialing leaves in the middle of a new application or ongoing process, a practice is at risk of losing its progress. It will certainly create disruptions and will often leave the practice with no clue how to proceed.

Outsourcing credentialing will greatly eliminate the risk of this type of turnover. A committed credentialing company will mitigate any employment gaps by ensuring that a healthcare practice is never left wondering about any details of an account or any step of the credentialing process.

It just makes sense.

Although a healthcare practice may be able to handle credentialing internally, is it worth the risk of missing a serious error? Or of making a mistake that can diminish cash flow and reputation? Is it worth the labor costs and time to figure out each insurer’s process when it will change in a few months?

Outsourcing is usually the smartest move a practice can make. It will get a practice’s credentialing done faster, with fewer headaches, and more security. This, in turn, frees up space for internal staff members to concentrate on maximizing patient care. Without a doubt, outsourcing insurance credentialing is the way to go.