There are many potential consequences and potential issues in the process of medical credentialing. Therefore, many healthcare practitioners are hiring credentialing companies to avoid compliance issues significantly.
What is Credentialing?
Credentialing is the verification of work experience, certifications, qualifications, or references of the nurses, doctors, healthcare providers, physicians, etc. In this process, you confirm the credentials of healthcare providers. Therefore, it is a safeguard put in place to protect patients by providing them access to high-quality and qualified health care professionals.
Credentialing Challenges:
- Often practitioners provide out-of-network services when they don’t meet the criteria of credentialing. Therefore, they provide medical treatments but do not get reimbursed in a timely manner for the delivered services. As a result, they face reimbursement collection challenges.
- Professionals face challenges if they don’t monitor Medicare’s revalidation process, check the process of re-attestation, and update their CAQH information. Moreover, they still have to need to track their compliance standards or not rely on Medicare Administrative Contractor (MAC) and the CAQH to notify them when there is a time to revalidate/re-attest.
- Healthcare professionals should ensure that they are receiving Medicare’s revalidation and CAQH’s re-attestation email notifications to prevent further complications. Moreover, they should check that the HIPAA-compliant email system is not delaying the notifications, etc.
What is the Significance of Credentialing?
Medical credentialing is an important procedure but at the same time, it is a tedious, complicated, and time-consuming process if not done properly. Moreover, there are tons of mistakes and problems associated with this process that can impact the efficiency of a medical practice significantly.
But, when you hire credentialing companies, you get access to credentialing experts who communicate directly with the medical staff to give essential updates for (National Plan and Provider Enumeration System )NPPES, (Council for Affordable Quality Healthcare)CAQH, (Provider, Enrollment, Chain and Ownership System)PECOS, etc. So, healthcare practitioners rely on credentialing experts to stay updated with the contract updates respectively.
Individual providers and health systems must manage the latest credentialing updates or requirements. But maintaining and establishing credentialing is a difficult task. Moreover, navigating through a proper channel, questions, terminology, and applications is a critical challenge for many practitioners.
Moreover, every insurance provider has its own innovative procedures and unique guidelines. So, when you hire credentialing companies, their qualified teams can help you with this complicated process as well as identify all problematic issues by fixing them in a timely manner.
4 Reasons to Hire a Credentialing Company:
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Protects From Potential Lawsuits:
There exist legislations and laws that need credentialing on legal documents such as; medical records and prescriptions, etc. Moreover, these constitutions also cover professional activities like research publications, legal testimony, and speaking engagements, etc. So, without the appropriate process of credentialing, you can miss the necessary things required by the law.
So, when you hire a credentialing company, you become able to meet all the necessary requirements of the legislation. It allows the registration of clinics to the National Practitioner Data Bank queries, which provides a clear view of the providers’ malpractice claims history. So, it allows a practice to run smoothly, safely, and legally.
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Cost Savings:
Due to the latest strains in the budget of the medical practices, practitioners are struggling hard to streamline the hospital processes as well as lower the operational costs remarkably.
Therefore, when you hire credentialing companies, you become able to take advantage of the electronic credentialing process. It enables you to shift to the cloud-based computing system from the payer system. Moreover, it helps you reduce costs/overheads without impacting the safety and health of people significantly.
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Prevent From Losing Revenues:
It is necessary for all medical facilities to partner with the right insurance careers. Thereby, failure to acquire proper credentialing by the practitioners can delay the reimbursements from the insurance payers.
Moreover, the insurance carrier backdates the reimbursements process if a medical office allows the physician to give services prior to credentialing. Ultimately, it affects the revenue stream and causes disruptions in the cash flow significantly.
Hiring credentialing companies helps you focus attentively on the credentialing process, get paid in a timely manner, and reduce revenue loss efficiently.
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Improves Patient Trust:
Trust is a prerequisite between patients and healthcare professionals in the healthcare system. It enables the patients to disclose and open up information about their perception for approval of the recommended treatment. Moreover, patients who know a little bit about the qualification of their physicians are less likely to fully trust the doctor.
Therefore, when you hire a medical credentialing company, credentialing experts confirm and assess the qualification of healthcare providers, physicians, and doctors according to merit/experience. In this way, it enables patients to build complete trust in their physicians significantly.
Take a Lead:
Medcare MSO is the most reliable medical billing company that provides a comprehensive suite of innovative Healthcare IT solutions to optimize healthcare revenue cycle management for improved revenue. Click here to visit our website and learn more about our medical billing and coding services. Our dedicated team provides efficient medical credentialing services to protect healthcare institutions from harm. Contact us today to reduce costs and improve practice proficiency!
