The rapid growth of the healthcare system places a demand on healthcare facilities to onboard more providers to expedite patient care. This translates to long hours spent on provider verification, credentialing, and paperwork, which can sway admin teams.
For most healthcare facilities, the question is no longer whether to optimize credentialing. The questions are, “How much does it cost compared to the benefits and ROI?” and “How can we do it without compromising provider privacy, accuracy, and regulatory control?
This article explores how outsourced medical credentialing answers these questions, offering a smarter, scalable path forward for modern healthcare systems.
What is Medical Credentialing?
Medical credentialing is the process of vetting healthcare providers’ licenses, certifications, qualifications, and criminal records. According to the American Medical Association, medical credentialing is often the first of a three-phase process. This process is one that healthcare professionals must pass through to ensure they meet industry standards and are verified before practice.
The healthcare system deals with patients’ lives, so a little error can have devastating consequences. This is where medical credentialing comes in to verify that every provider is qualified to practice. It ensures patient safety and mitigates the risk of legal, financial, and compliance issues that arise with unverified providers.
Credentialing consists of filling out and submitting applications, primary source verification, background checks, and a committee review. After the committee review, the approved provider is granted privileges and is enrolled to bill for health services provided.
With any error, mismatch of documents, or clashing details, the application is returned to the provider/healthcare facility for correction, often causing the process to span months on end.
Challenges of In-house Credentialing
While in-house provider credentialing has its perks, it is limited. The rigours of credentialing cause internal teams to struggle with the workload of the process. This shifts their attention from patient care to administrative tasks.
Some more challenges include:
Time Consuming and Labour-Intensive Process
Credentialing requires going through each detail and entry to ensure accuracy. Also, various providers (physicians, nurses) undergo different types of credentialing processes, constituting an enormous amount of paperwork. Add to that primary source verification, background checks, and credentialing committee reviews, and you have a process spanning 120 days+. As such, it is time-consuming and labour-intensive. This slows down provider onboarding and limits access to specialists that patients should access for health issues.
Compliance Risks and Data Management Issues
Healthcare facilities are required to comply with strict regulatory laws and guidelines, like:
- National Committee for Quality Assurance (NCQA)
- Center for Medicare and Medicaid Services (CMS)
However, internal credentialing teams can sometimes mishandle provider data or overlook application errors, increasing the risk of onboarding unverified providers. As a result, patients may receive care from individuals who haven’t been properly vetted or have their data accessed by unauthorized personnel. This can expose the facility to legal, financial, and reputational damage, as well as compliance consequences.
Hidden Costs of Internal Credentialing
Credentialing is a rigorous and time-consuming process. Internal teams often struggle to follow through the process for various providers at once. As such, administrative teams begin to focus less on internal systems and structures. Patient care and general administration of the healthcare facility begin to fray under the burden of credentialing rigors. Even physicians aren’t left out, as they lose over $120,000 due to credentialing delays.
Benefits of Outsourcing Medical Credentialing
Outsourcing medical credentialing involves letting healthcare provider credentialing solutions and teams handle the credentialing process for healthcare facilities.
This frees facilities to focus on patient care while credentialing experts handle the complex, time-consuming tasks of verifying provider qualifications, managing documentation, and ensuring compliance with regulatory standards.
The benefits of outsourcing medical credentialing include:
Cost Savings and Operational Efficiency
Outsourcing speeds up the provider credentialing process. The catch? Providers get enrolled faster, and insurers can be billed faster, thus improving the finances of healthcare facilities. On the flip side, providers spend less time checking for errors and redundancies in application forms, thus helping them to focus on providing excellent patient care. Administrative teams also focus on internal administrative tasks like insurance verification rather than mundane paperwork.
Access to Expertise and Compliance Assurance
Unlike in-house admin staff, healthcare provider credentialing services focus only on credentialing and associated processes. So, obviously, these teams receive training and possess expertise that helps them optimize the credentialing process. Because these teams have their focus streamlined solely on credentialing, they can easily spot errors, redundancies, gaps in work history, and other verification issues.
Consequently, healthcare facilities run a lesser risk of failing compliance rules and the attendant legal and financial issues. These credentialing services also handle the post-credentialing process of ensuring that the licenses and qualifications of providers stay updated.
Scalability and Technology Integration
The major processes involved in credentialing require human input. But, these solutions know exactly where and when to use automation (i.e, in flagging errors and missing documents). This speeds up the process, helping healthcare facilities to onboard and enroll providers faster.
Scalability also becomes easier. Faster onboarding means that healthcare facilities can hire more providers faster and earn revenue via insurance reimbursements—without necessarily expanding the admin team.
Measuring the ROI of Outsourcing Credentialing
Outsourcing the credentialing process isn’t about care. It’s about maintaining expertise, increasing efficiency, and reducing possible errors. The ROI of outsourcing credentialing includes:
Reduced Processing Time and Faster Revenue Cycle
With smart credentialing workflow automation and the expertise of external teams, the vetting process takes less time. Providers spend less time on back-and-forth correspondence and more time on patient care.
Some credentialing solutions also come with Revenue Cycle Management as a package. These RCM providers also offer claims management, decreasing payment integrity issues and billing errors for healthcare facilities, culminating in a faster revenue cycle.
Lower Admin Costs and Error Reduction
Healthcare provider credentialing solutions like Verisys are less prone to errors, thanks to their specialized expertise and use of solutions like provider data verification. By partnering with them, organizations minimize the risk of onboarding unverified practitioners, ensuring patient safety and regulatory compliance.
As a result, they can streamline internal operations and reduce staffing costs, allowing a leaner admin team to focus on core tasks like patient record management and scheduling.
Why Healthcare Organizations Should Consider Outsourcing Credentialing
Healthcare credentialing outsourcing might cost more initially, but the long-term financial and operational benefits weigh more. The key step is deciding if your facility’s credentialing is ripe for outsourcing. Also, consider pricing, the trustworthiness of the credentialing service, the packages they offer, and the size of your facility.
Verisys employs hospital credentialing solutions to ensure you have a seamless vetting process. We offer provider data management efficiency and transparency, providing you with timely updates so you maintain oversight of the process. Streamline your credentialing process today with Verisys.
Sources
TechTarget, Physicians lose the most from provider credentialing delays
American Medical Association, Credentialing 101
