From setting up a practice, arranging equipment and medicines to managing administrative conundrums, the costs involved in healthcare are unending and continue to rise with every passing day. Add to that the credentialing costs or getting paneled with insurance companies.
Credentialing is one of the most essential steps of Revenue Cycle Management for healthcare providers. It strengthens their practice and allows them to cherish a continuous flow of income. It opens the door for healthcare providers to reach more patients and offer care with greater trust and accessibility.
Provider credentialing is like a driver’s license for a physician or healthcare provider. It gives them legal permission to attend to patients with coverage from different insurance providers. Doctors and physicians can bill them and achieve timely and complete reimbursement.
Getting credentialed with Federal Health Insurances like Medicare and Medicaid, and private/commercial insurances like Aetna, Cigna, Delta, UnitedHealthcare, allows healthcare providers to expand their patient base. It helps them to maintain compliance, ensure patient safety, and maintain financial stability.
Credentialing Is Hectic, Time-Consuming And Expensive
With all the pros, there are some tricky aspects of credentialing that can never be overlooked or underestimated. One of the most significant is that credentialing is time-consuming. It includes lengthy wait times and may take several months for a physician to get paneled with an insurance company.
Other than that, it’s detail-oriented and requires you to be organized. You must gather essential information and present it to the payor. This includes educational proofs, such as diplomas and transcripts, state licenses, NPI numbers, DEA numbers, board certifications, tax documentation, and clinical practice information.
Above all, credentialing can be expensive. There are multiple direct and indirect costs involved, which can accumulate, resulting in affecting the doctor’s or practice’s bottom line. For instance, on average, providers suffer $6000-8000 every month. It takes around 90-120 days for a new credentialing application for commercial insurance.
DIY Is Not Easy! Expert Help Is The Ultimate Solution
Doing it on your own may result in burnout and loss of valuable time, as it takes more than 20 hours for every application. You may have to incur $50-300 as credentialing software fees if you want to invest in technology. Apart from credentialing costs, another tricky part is that healthcare providers are included in every insurer’s panel at once. They must submit a separate application to get registered with them.
For instance, if you’re credentialed with Cigna, that doesn’t mean you can attend to patients backed by Delta or UnitedHealthcare. You must apply separately to get registered with other insurers. Remember that getting credentialed with various insurance companies and having a strong payor network is rewarding in the long run.
Before we move to the financial implications of credentialing, let’s tell you what provider or physician credentialing is.
What Is Healthcare Provider Credentialing?
Credentialing is a rigorous procedure of verifying and assessing a healthcare professional’s credentials, like professional qualifications, educational certificates and diplomas, training proofs, certifications, licenses, and professional history.
Simply put, it’s a screening process to check if the provider is experienced and competent in providing safe and high-quality medical services. The purpose of scrutinizing these requirements ensures that the doctor, physician, nurse, or any medical care specialist meets regulatory, institutional, and insurance standards.
Factors Influencing Medical Credentialing Costs
The costs involved in Medical credentialing may vary based on multiple factors, like the type of specialization, the state in which you’re operating, insurance type, etc. To make it clear, let’s go through these factors one by one.
Healthcare Provider Type and Specialization
The role or type of healthcare provider wishing to get credentialed is the foremost factor in determining the exact costs incurred during the process. For instance, a massage therapist may get credentialed in less time than a cardiologist due to their extensive verification and considering the claim bills to be reimbursed.
Likewise, a nurse practitioner will not have to suffer the same credentialing costs as an ophthalmologist due to fewer necessities. Also, for allied health professionals, the prices to credential may fluctuate depending on the specific functionality and required documentation.
Doing It In-House
Getting credentialed on your own or assigning it to an in-house staff member may seem like an easy solution, and succeeding also seems like a feat achieved. However, accomplishing it in-house not only takes a lot of time and energy, but you’ll also have to serve many hours for this exact purpose or allocate a staff member solely for this purpose.
Sometimes the number of hours taken, technical communication, collecting and presenting all necessary documents, going back and forth with the insurance company, rising waiting times, when combined, can be extremely overwhelming and put you off of your primary duties. Doing it in-house means increased administrative tasks, extra costs incurred on credentialing software, staff training, allocating resources, and paying them salaries.
Number of Insurance Companies
Every insurance company, whether private or government programs like Medicare and Medicaid, has its own credentialing process. The more payors you want to work with, the higher the costs. And as you add more providers to your credentials, expenses rise further; whether you manage it in-house or outsource it.
Outsourcing Provider Credentialing
If you decide to outsource credentialing to a third-party credentialing specialist, you’re taking the right path towards simplicity, reliability, and affordability. This way, you get peace of mind that a professional RCM company like I-Med Claims will accomplish all the technical communication with the payors, and they’ll do it faster with more expertise.
Although the credentialing service providers take the burden off your shoulders, it comes at a price. Based on the type of credentialing, specialty, and state, they may charge you $300 to $1000 per insurance company. For most healthcare providers, this is the feasible solution of the two, as the third-party firm also provides reliable customer support and assists in case of any obstacles faced post-approval.
State Requirements
When it comes to credentialing costs, healthcare providers in different states have to pay varying credentialing costs. For instance, credentialing costs in Mississippi would be different from those in California. Moreover, some states demand additional verification or documentation, which leads to more time taken for the credentialing process and more expenses, too.
Initial Credentialing Vs. Re-Credentialing
As a healthcare professional or someone associated with the medical field, you must be aware that initial credentialing is usually more expensive as compared to re-credentialing. The reason is that it includes extensive details and verification.
On the other hand, re-credentialing is required every 2-3 years. It is less expensive, but it still involves time, documentation, verification, and other details.
Direct Credentialing Costs
Direct costs include upfront and immediate charges that healthcare providers and practices must pay for the credentialing process. These processes include application fees, verification costs, and other steps involved. Let’s break them down for your easy understanding.
Application Fees
Before we go into the details, it is important to remember that application fees may differ based on the level of credentialing, like CAQH fees, insurance panel fees, etc.
State Medical Board Fees
Fees paid on account of licenses and renewals are covered in this part. This is the most burdensome part of credentialing, and providers are expected to pay hefty amounts ranging between $750 and $800. The test fees to check provers’ competence costs anywhere between $1400 and $1950 along with an oral exam, for which the fees normally range between $1540 and $1900.
Insurance Panel Enrollment Fees
To be part of insurance networks, the healthcare providers are asked to pay an upfront cost of $100 to $200. These fees are paid on a per-application basis, and the more insurance panels you want to join, the more fees you have to pay. These joining fees are their ticket to send claims to the insurance company for reimbursement against the provision of the services.
Hospital Privileging Fees
There are no direct costs involved in obtaining hospital privileges. However, the process can take time and effort, as hospitals often require thorough background checks, verification of credentials, and proof of training and experience. While you don’t pay a fee for the privilege itself, you may still invest resources in gathering documentation and completing the application process.
CAQH Proview Fees
Healthcare providers don’t have to pay any fees to use CAQH ProView. The platform is totally free to use for individuals or solo practitioners. However, healthcare organizations usually pay for these fees if they want to use CAQH for credentialing to leverage extra features and bulk verifications. The CAQH fees include annual and administrative charges for accessing the provider database.
Primary Source Verification Costs
It is an essential part of credentialing used to confirm the authenticity of the applicant’s healthcare provider’s credentials. It includes the provider’s qualifications, medical licenses, board certifications, degrees, and diplomas, either from a governing body or by contacting their original issuing institution. Let’s now go into the details of these.
Education and Training Certificates
These include the costs incurred to verify the medical professional’s degrees and residences. In some instances, the costs can increase manifold as the verification may involve local or international travel to confirm the authenticity of educational documentation and certifications.
Board Certification Verification
Confirming the authenticity of board certification is another fee that adds up in the credentialing costs. It can cost up to $395 per provider.
Background Check Fees
It is another important aspect of the credentialing process and is mandatory in some states. Based on the severity of the background check, this step of the process may cost providers somewhere between $50 and $250.
Malpractice History Reports
Healthcare providers or the organizations, clinics, or practices they are associated with may have to pay $9 to $12 for every medical professional to verify malpractice insurance and claims history.
License Verification Costs
These payments vary based on geographical locations, such as states. For instance, the fees in one state may not be the same as those in the others. However, they don’t put a large dent in the credentialing budget and often fall between $40 and $100 per license verification.
Indirect Credentialing Costs
Indirect costs are totally different from direct costs, which include application fees and verification fees. These costs are in the form of excessive administrative load, workload burden on staff, effect on operational efficiency, and impact of more tasks translating into resource burnout, disrupting the organizational structure and budgets.
Increased Administrative Burden
As you may know, credentialing is a resource-heavy and intensive procedure that can directly impact the workflow. As it requires significant time and skill, it can disrupt the work and create backlogs.
Staff Time and Labor Costs
It is an understood thing that credentialing experts or an outsourcing company trying to get physicians credentialed with an insurance have to spend long hours organizing documents, following up with the payors and verifying details. On average, the salaries for credentialing and enrollment specialists cost an organization between $45918 to $57693 per annum.
Training Requirements
To educate the staff regarding the latest regulations, credentialing software and best credentialing practices, organizations spend a hefty amount. The average cost to train an employee is $500, and it can vary based on the number of sessions, periodic trainings, and other variables like comprehensive training or specific training like Medicare Credentialing or teaching them how to get a provider credentialed with a private/commercial payor.
Documentation Management
Keeping records safe and well-organized takes both time and the right technology. Most document management systems come with a monthly cost that can range anywhere from $15 to $200, depending on the features you need.
Technology and Software
There’s no doubt that the technology has eased many tasks and brought about efficiency and accuracy in the healthcare and RCM steps, like credentialing. The use of credentialing and documentation organizing software has made the job easy and lowered the manual labor involved.
However, apart from streamlining the processes, the costs for acquiring and running software accumulate into the credentialing costs for healthcare providers. As most of the software is subscription-based with recurring fees, the costs just keep adding up.
Here’s how technology integration affects credentialing costs.
Credentialing Software Licenses
You may be aware that most credentialing software is offered on a monthly subscription. The cost usually depends on the number of users and the level of access, with prices often ranging between $50 and $300 per user each month.
Database Subscriptions
Apart from software subscription and recurring costs, you’ll also have to pay the subscription fees for accessing to the NPDB (National Practitioner Data Bank) which is a meager $2.5 to $3. However, these costs are only against one paneling. So, when you’re looking to get registered with multiple insurance companies, the costs can add up.
Electronic Verification Systems
EVS or Electronic Verification Systems have simplified the credentialing process. They have reduced the manual burden on employees, and most providers love to detangle the verification process through these systems.
Hidden Costs and Considerations
Besides the costs mentioned above under direct and indirect charges incurred for credentialing, this significant aspect of revenue cycle management also involves some hidden expenses. These include:
Revenue Loss During Waiting Periods
Waiting until the credentialing is complete is a painstaking stage. During this time, the providers cannot deliver healthcare services to patients and bill the insurance provider claiming the deserved reimbursement. This causes serious financial strain and results in delayed revenue generation.
Reapplication Fees for Expired Credentials
Expired credentials are another cause of hidden costs or loss of revenue. Not renewing your credentials on time, before the deadline specified by the insurance companies, also means additional fees and delays in payments.
Expedition of Processing Fees
If you want to speed up the credentialing process, i.e., get it done faster than the normal timeline, you may have to pay an extra fee. That extra fee can be quite high, which is around $200 or more for each provider being credentialed. Simply put, you can get credentialed a lot faster, but it comes at an additional cost per provider.
Cost of Credentialing Errors
While doing provider credentialing, there’s no room for errors, and every step must be taken with utmost care. If you’re not careful and don’t pay attention to details like submitting the application the correct way, or not responding to payor requests or queries, you could end up delaying the process of credentialing.
How to Keep Provider Credentialing Costs Down?
Here are some smart habits or points that can help you push credentialing costs down. So, instead of stressing about the rising costs at every step you’ll have predictable costs in mind for your clinic, practice, or hospital.
Pick the Right Partner
If you’re outsourcing, choose a credentialing company with transparent pricing and a strong track record. Compare a few options before deciding the right partner can save you money and headaches in the long run.
Use Credentialing Software
Good software can handle repetitive tasks, catch errors, and speed things up. While there’s a subscription cost, automation reduces manual labor and lowers overall expenses.
Plan Ahead
Starting the credentialing process early helps you avoid rush fees and costly delays in billing. Setting reminders for re-credentialing deadlines also keeps you compliant and stress-free.
Submit Applications in Bulk
Whenever possible, send multiple payor applications together. This saves time, streamlines the process, and can even help you negotiate better rates with third-party services.
Train Your Staff
If you’re handling credentialing in-house, make sure your team is properly trained. Skilled staff can process applications efficiently, reduce errors, and keep costs under control.
Outsource vs. In-House
Outsourcing lowers administrative work and reduces errors, but it may feel costly upfront. In the long run, however, it often pays off. On the other hand, if you have fewer providers and a trained in-house team, handling it internally can be more cost-effective.
Renew Early
Keep track of expiration dates and renew credentials ahead of time. This prevents last-minute rush fees and avoids the expense of having to reapply from scratch.
Leverage Group Discounts
Larger practices can save by enrolling providers as a group. Many credentialing services and payors offer discounted rates for bulk enrollments or shared services.
Final Words
Credentialing may not be glamorous, and the smoothest RCM process for healthcare providers. It is tedious, difficult, technical, time-consuming, and requires extensive knowledge. But you have to have it, whether you like it or not. You have to spend a substantial amount to obtain credentialing and re-credentialing to practice in the American healthcare landscape. Credentialing costs are rising and you must bear them. They are unavoidable.
It requires a lot to get credentialed and re-credentialing for every insurance company you want to get paneled with, which can divert your attention from your primary duties and affect the provision of healthcare.
To overcome these difficulties and administrative burden from slowing you down, why don’t you outsource credentialing to I-Med Claims, a highly renowned, reputable, and skilled credentialing services provider in the US? At I-Med Claims, we not only expedite provider credentialing but also enable them to save substantial credentialing costs.
We implement optimized strategies to get the job done as quickly and efficiently as possible, give them a clear picture of all the costs involved, help them organize and collect all required documentation, and enable them to reap rewards with the ROI of proficient credentialing, be it Medicare, TRICARE, or any commercial payor.
Ready to get credentialed affordably and without compromising on patient care? Get in touch with our credentialing gurus today.
