Why is provider Credentialing important for every practice?

Wondering why medical Credentialing is important for your practice? Patients want to trust their health to a qualified healthcare professional. If they are not sure about a physician’s merit and experience, they won’t come back to that practice. So if you don’t want to lose patients and revenue, then medical credentialing is a necessity. It allows patients to place their trust in their chosen healthcare professionals.

What exactly is medical credentialing?

In this process, hospitals, insurance networks and healthcare organization’s obtain as well as evaluate documentation about a medical provider’s training, education, work history, compliance record, licensure and various other things. This evaluation is done before allowing that provider to participate in a network for treating patients at a medical facility or a hospital.

There are several factors taken into consideration during the credentialing process:

  • Training
  • Education
  • Residency
  • Licenses
  • Experience
  • Certifications

Since partnering with insurance carriers is an important procedure for medical offices, it is necessary for physicians to provide a list of verification to insurance carriers, including Medicaid and Medicare. This needs to be done to become eligible for reimbursable expenses.

What if there is no credentialing?

If you are not obtaining proper credentialing, then get ready to face revenue loss. No practice should allow medical providers to perform services for patients without proper credentialing. This is because insurance companies will not pay any medical office that is billing for healthcare providers that have not been credentialed.

For instance, if a physician hasn’t been credentialed but he/she performs a service, the insurance company will backdate the reimbursement of your practice for covering the services provided. If you are taking this kind of risk, it will cost thousands of dollars to your practice and this money will be difficult to collect from the insured or the insurance payer.

Considering the fact that there are many doctors trying to compete for a space in the insurance company panel, it is becoming very difficult to get credentialed. Therefore, it is recommended for practices to submit their provider enrollment packet, including the required documentation and verification as soon as possible.

Also, provider credentialing is an ongoing process which means, just a one-time evaluation check or verification won’t be sufficing. With the right type of credentialing, it can be ensured that your patients are receiving top-rated healthcare. It will also speed up the reimbursement process.

Leave a Reply

Your email address will not be published. Required fields are marked *