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Guide to Physician credentialing

A Comprehensive Guide To Physician Credentialing Services

Medical credentialing is important in various ways, including ensuring patient outcomes, preventing lost reimbursement possibilities, fines, penalties, and inspiring a simplified working culture in healthcare facilities that meets the highest benchmarks. Physician credentialing is a necessary process to generate revenue. Physician credentialing delays and missed appointments have direct financial impact on the provider and the practice. As a physician, you must be credentialed and in good standing with several major insurance companies. You must prioritize this task to improve your practice’s effectiveness and better serve your patients.

Challenges Involved In Physician Credentialing

Physician credentialing is a comprehensive process of obtaining and validating all information related to a physician’s education, medical certifications, employment history, and career gap to provide quality patient care under consistency. Incorrect or insufficient information and the absence of any required supporting documents can lengthen the process. Managing physician credentialing needs skillful hands that have gone through the procedure previously.

When Do Physicians Need To Be Credentialed?

  • When starting a new practice, providers must go through this process.
  • When it comes to becoming a participating provider
  • When introducing additional service providers to an existing group
  • When carriers demand updated information

Checklist For The Physician Credentialing Process

  • Completed Credentialing Application with all required information
  • Board Certifications and Medical Graduation
  • Details on internships, residencies, and affiliations
  • CME completion certificates 
  • Current CV and recent photograph
  • Proof of gap in work history 
  • Copy of Social Security Number (SSN) and Driver’s License
  • National Provider Identification Number(NPI)
  • Malpractice Insurance Coverage details
  • CAQH and NPPES details
Guide to physician credentialing

Advantages Of Physician Credentialing 

Main advantages of physician credentialing services are as follows:

Ensured quality

Medical credentialing ensures quality in the healthcare sector. It is a review method for the healthcare profession. In other words, it ensures that the medical sector consistently meets quality standards for patients. Insurance companies are only interested in well-off medical doctors to keep costs low. They also look for those who have demonstrated the ability to promote their specialties.

Better Payment

Insurance companies pay healthcare professionals on par with the insurance. Credentialed physicians benefit greatly in the long run because they are not afflicted with the need to obtain more money from patients. Patients treated by these doctors benefit from receiving the highest possible payment.

Access To The Fee Schedule

Physicians who work with insurance companies have access to an accurate fee schedule for various medical procedures and services. This fee schedule will specify the maximum reimbursement boundaries for various services and will assist physicians in sending appropriate claims.

Serve More Patients

Credentialed physicians are regarded as reliable providers and are included in the ‘preferred physicians group,’ from which patients typically choose their physicians to maximize benefits and prevent unnecessary ‘out-of-pocket expenses.’ As a result, credentialed physicians see more patients than non-credentialed physicians.

Save Your Revenue

Proper credentialing save medical professionals thousands of dollars in reimbursement revenue. If there are mistakes in the procedure or if the patient does not receive proper credentialing, insurance companies may refuse to reimburse the medical bills for the treatment.

In cases where medical practice allows a physician to provide services before or during the credentialing process, the insurance company can advise patients to seek full reimbursement to cover the treatment costs.

Enhance The Hiring Procedure

If a physician is credentialed, they must undergo a thorough examination of their academic background, residential history, job experience, and other qualifications. If your medical practice wants to employ a credentialed medical practitioner, this process will help you determine whether they can perform the work activities.

Benefits Of Outsourcing Physician Credentialing 

Outsourcing physician credentialing process is a great way to guarantee timely registration while saving money. Having a professional credentialing team on your registration process can help accelerate and prevent unnecessary problems due to missing or insufficient data. An established medical billing company should be able to protect your provider credentialing needs and keep track of re-credentialing and ongoing credentialing maintenance activities as needed. We have been providing a strategic approach to each credentialing process. Our Credentialing team can ensure that your applications are accepted on the first submission. We promise to avoid revenue pitfalls due to incomplete or delayed physician credentialing and ensure exponential revenue growth.

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