Outsourcing Your Credentialing Services

  • May 01, 2019

  • Healthcare facilities exist to administer medical care to their patients. While infection prevention, cures, disease management, operating room efficiency have advanced more so than any other time in history, the roadblocks to running a successful medical practice have actually increased in size.


    Every medical practice, is continually faced with a constant daily barrage of challenges that aim to prevent or limit the practice’s payment for services. Within the revenue cycle, physician credentialing and insurance enrollment represent one of several obstacles in obtaining timely payments. Provider enrollment or Insurance credentialing has become one of the most complicated and confusing processes within any industry, which is why outsourcing your credentialing and enrollment department could make your medical practice more profitable.


    Increased Efficiency:

    Efficiency is of the utmost importance within every industry and healthcare is no exception. If you’ve been running a medical practice, you know that the credentialing and enrollment process often feels like you’re walking blindfolded through a labyrinth.

    Credentialing professionals get out of this entanglement by relying on advanced technology and payer relationships. The alliance that bypasses the customer service department usually results in at least 30 days taken off of the entire credentialing process. In addition to the relationships, advanced technology utilized by professional credentialing agencies ensures the accurate and timely submission of all applications and forms, as well as ensuring that the correct forms are used and delivered to the correct address, fax number or email.

    Reduced Labor Costs:

    Have you actually taken a close look at what the credentialing and enrollment process is costing your medical practice or healthcare organization? More than likely the person handling your insurance enrollment and credentialing also has several other responsibilities. Unfortunately, these other responsibilities typically replace enrollment and credentialing needs as the top priority.

    With rising costs and declining reimbursements, most practices are forcing more and more on their limited number of employees. While most would agree with watching labor costs and distributing work across the practice, it’s critical that certain compliance and credentialing requirements remain at the top of your staff’s to-do list. More than likely your current staff’s workload is unsustainable and is resulting in unnecessary overtime and errors.

    Outsourcing to a professional organization, not only reduces the stress level on your staff, but also ensures the top priorities of your organization do not get overlooked. One error within the credentialing process could literally bankrupt your practice. Whether it’s a Medicare revalidation ignored resulting in the deactivation of PTANs or recredentialing requests that are tossed and result in termed contracts, do you really want that added liability?

    Eliminate Risk of Turnover:

    Regardless of how incredible your practice or organization is, there will always be turnovers. It seems to be some unwritten part of Murphy’s Law, but when it occurs, it usually happens at the worst possible time.

    How will your organization be affected by turnover in your RCM or credentialing department? Commitment to cross training, disciplined project accountability and tracking ensure that management is never left in the dark regarding the status of an account and anyone, at any moment can pick up where someone else left off.

    In summary, outsourcing your credentialing and provider enrollment is the equivalent of a primary care physician referring to a cardiologist when a patient presents with an irregular heartbeat. While the primary care physician could very likely handle the problem internally, is the risk of missing something serious worth it? Are you certain that your current credentialing needs are being handled efficiently or being done incorrectly by someone who lacks proper training or experience? Based on national credentialing surveys, the average time for a physician to be credentialed by a group is 180 days. Is finishing the process faster and more accurately important to you? If it is, we believe you’ll reach the logical conclusion that outsourcing is the answer.

    For more information on outsourcing your credentialing and provider enrollment, call RevPro Healthcare Solutions at 561-578-8400.