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The Importance of Outsourcing Physician Credentialing Services



Physicians Credentialing Services is necessary to acquire for reinforcing the revenue cycle for a smooth running physician practice. The credential services supplier keep on tracking referrals from patients and cash flow on a consistent basis.

Physician Credentialing Services are gaining much importance since healthcare practices are recruiting a large number of healthcare experts. Credentialing is a complex process and lengthy process which asks for proper expertise and expert management. For that reason, it’s better for a healthcare practice to outsource Physician Credentialing Services to yield desirable outcomes as well as to focus well on the care delivery process.

Credentialing with government and viable payers is amongst the challenging and complex aspects of running and/or establishing a medical practice. When you outsource to some credentialing services Provider Company you procure most favorable Physician credentialing services with the inclusion of the following:

1. Medicare and Medicaid Provider Enrollment

Provider Enrollment is a process of asking for partaking in a network of health insurance as a partaking supplier. It undertakes the following steps:

• Enrollment with a plan

• Filling the application for plans credentialing

• Submitting duplicates of licenses

• Insurance, and other documents

• Agreeing to a contract

Credentialing is a determinant for the acceptance of the request of a supplier for enrollment. Credentialing ensures that the supplier is well-educated, well-skilled and fulfills the particular requirements of the insurance network for enrollment. Subsequent to the completion of the credentialing process, the insurance network makes a deal with the supplier for partaking.

2. Insurance Contract Negotiations

Physicians and healthcare companies need to struggle hard to collate maximum possible amount of money. A large number of organizations do not go for renegotiation and only a small number of them renegotiate on a yearly basis. Rendering to these statistics, a single healthcare practice loses 10-25% of its overall wealth in the bank of the insurance company. When you outsource Physician Credentialing Services, you get also Insurance Contract Negotiation which entails

  • Accurate analysis and inspection of all existing contracts
  • Evaluation of the payer contracts and the way they match up to the standards of the local market.
  • Suggestion for a strategy for contracting on the basis of your business goals and the existing setting of the insurance.
  • Consultation with payers with regard to measures for pay-for-performance and with regard to the fee schedule which fits best with the group
  • Determining the rate of losing referrals due to your not participation in specific insurance plans
  • Development and implementation of a suitable plan for renegotiating your insurance contracts
  • Delivering consistent updates to keep you up all through the negotiation process.

3. Contract Evaluation Services

Adding to the contract negotiation services, credentialing companies also provide services to evaluate the contract to make sure you get to know accurately the way you are being paid. The standard process of evaluation is to fulfill the evaluation process of a thorough contract prior to the start of any project for contract negotiation.

4. Payer Fee Schedule Creation & Evaluation

Scheduling the creation of the fee for the payer is essential to acquire the true in turn of investment.

5. Credentialing Tele-health

Credentialing to telehealth or telemedicine is required for a physician which determines their eligibility for providing them hospital privileges. The process of Privileging evaluates the competence of the physician in his/her specific field of practice.

Physicians providing telehealth, regardless of not being physically in the hospital, yet require undergoing the process of credentialing and privileging for the remote institution.

However, this process is long and costly and requires ample of relevant resources.

To sort this out, there is a way called “privileging by proxy” which reduces the cost and overall resources.

6. Issues Regarding Reimbursement

The revenue cycle in the healthcare is facing a significant drop because of denied claims that occur due to mishandled medical billing and coding. It causes a lot of reimbursement issues and an imbalance in the revenue cycle hence causes a reduction in the cash flow. Outsourcing credentialing services also brings about the solution of reimbursement issues thus contribute to an improved state of reimbursement and uplift the revenue cycle. The use of right expertise and the right software to perform medical billing and coding in a precise manner is a key step to give a boost to your cash flow.

7. Medical License Application Processing & Renewals

For every healthcare practitioner, it is necessary to get a hold on to a medical license for ensuring smooth practice in his/her specific area of medicine. Obtaining a medical license is a not that easy and requires some complex steps. It involves filling up an application form and then it submitting for requesting a medical license. It also requires certification and verification from certain organizations which might be time-consuming. Moreover, after receiving the medical license, physicians are also required to renew their license. Outsourcing to a credentialing company makes the entire process very easy and smooth for you.

8. DEA Registration and Renewals

The DEA registration from the Drug Enforcement Agency allows the Physicians and other prescribers to prescribe controlled substances after to the clients. Obtaining a DEA registration can be sometimes a complex process because of the barriers such as prior verification or penalizing issues, the nature of the practice, the inadequacy of experience and the like. Outsourcing is a suitable option since it helps you to acquire and secure their DEA registration with the assistance of well-trained and well-qualified experts in a hassle free way. Moreover, it also aids in renewing the DEA registration every 90 days.

9. Council for Affordable Quality Health Care (CAQH) Registration

CAQH registration is a crucial step towards supplier enrollment and credentialing. With the escalating expense of the healthcare, registering to CAQH can aid in lessening the expense of the healthcare. Moreover, registering to CAQH centralized your demographics and credentials regarding information at a particular site. However, the process of CAQH registration is a bit complex and a lengthy one.



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