Essential Steps for Success with Provider Credentialing

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Provider credentialing is a complex, yet critical, process for virtually any healthcare provider. Without credentialing, reimbursement for providers can be delayed or denied – meaning that a practice’s revenue cycle depends on accurate and correct provider credentialing.

Credentialing involves a verification of a provider’s experience, expertise, and ability to provide meaningful medical care for his or her patients. This is especially important for enrolling in health care plans as a participating provider.

To ensure that your providers are successful credentialed, so that your revenue cycle continues on unfettered and unchallenged, here are essential steps for successful credentialing, courtesy of Medical Business Management.

Begin the Process Early

Provider credentialing isn’t something that can be successfully started at a moment’s notice. It takes careful planning – sometimes months in advance – whenever a new associate or provider joins the practice.

It is best to begin the credentialing process as soon as an offer is extended to a new provider. It can take several weeks for credentialing paperwork to be processed, which means anyone who begins a new term of employment with a practice without having the advance work done may not be able to bill for their services!

Many problems in the initial phases of credentialing can be solved by getting an early start on the process. If your practice is already behind, getting help with provide credentialing can be a way to catch up and get ahead of the game eventually.

Create an Efficient Process

Efficiency in the process can save valuable time and ensure your revenue cycle goes unhindered. This is not just for initial credentialing; it’s also for re-credentialing that is seemingly always pending, and for any annual updates that are often required.

Some practices create intricate spreadsheets that track hospitals, payers, and other third parties that need updates and have specific requirements for submissions (along with deadlines). Others use software that essentially performs some of these key tracking and recording functions (but still require extensive staff time). There is also the option of outsourcing provider credentialing to providers who can create a process for you and execute it on your behalf.

No matter what option you pursue, you need a process that you can easily replicate whenever a new addition joins your practice – and to handle re-credentialing on an annual basis.

Develop a Habit for Thoroughness

Being thorough is the key factor behind successful credentialing. When filling out forms for any credentialing database, it’s important to not leave anything blank, and to supply accurate information in full. All requested documentation should be provided. Anything left out of the process can cost you weeks in lost productivity as you have to catch up. It’s best to be completely thorough from the beginning and adopt a detail-oriented mindset for credentialing.

Outsource Provider Credentialing

The go-top method for ensuring successful provider credentialing today is to outsource it to specialists who have years of expertise and training in credentialing for healthcare providers.

Doing so will free up manpower, time, and resources. It will also ensure that your credentialing is in the hands of professionals who know the ins and outs of successful credentialing and can better ensure a smooth, efficient, accurate process that doesn’t negatively impact your revenue cycle.

Contact Medical Business Management for more information on our provider credentialing services that can be a powerful boon to your practice’s operations.