Pros and Cons of Outsourcing Credentialing Services

You recognize the credentialing headache too well if you are a physician or practice manager in the United States. It begins with a basic objective of adding yourself as a new provider or a contract renewal. However, for some providers, it ends with a desk covered under CAQH updates, primary source checks, and unnecessary holds from insurance payers.

Credentialing is not simply paperwork anymore, it is the key to earning revenue. A non-enrolled provider cannot bill, and without the ability to bill, the practice will lose money on a daily basis. 

This blog will answer the key question of why to outsource your credentialing, considering the pros and the challenges that you might face.

What are Credentialing Services?

In the simplest terms, credentialing services mean the exhaustive process of verifying a healthcare provider's qualifications. This involves their education, training, licensure, and clinical experience. It consists of two separate phases:

• Credentialing: The checking of the background of the provider in order to make sure that he or she is up to the standards set by the facility or the regulatory agencies.
• Payer Enrollment: This involves making a verified provider an in-network provider of insurance plans such as Medicare, Medicaid, UnitedHealthcare, or BCBS. So that your practice can be reimbursed.

What Does Outsourcing Credentialing Services Mean?

Credentialing ensures reimbursement, yet it often remains an undervalued and overlooked aspect. Here’s how outsourcing can help your practice:

• By outsourcing, you can transfer the whole burden of credentialing off your front-desk employees or office manager to a third-party agency that specializes in it. 
• Your staff no longer spends long hours on applications, manually searching diplomas and peer references.
• You get a dedicated team of professionals for the data entry, the follow-ups, and handling notice of missing document messages from payers.

Benefits of Outsourcing Credentialing Services

If you are wondering why to outsource your credentialing. Then these pointers can provide you with clarity

1. Significant Revenue Protection and Speed

The biggest pro is speed. While in-house teams often take 90 to 120 days to complete enrollment, professional agencies often cut that time by 30% or more. They are familiar with the shortcuts and even the requirements of each state and payer. 

2. Less Administrative Burnout

Once the primary source verification load is off, your staff can concentrate on front-of-house collections and the patient experience. Such a change enhances morale and decreases turnover, which is a constant problem in medical administration.

3. Knowledge in Compliance and Re-attestation

Credentialing isn't static. With CAQH quarterly re-attestations and the changing standards of the NCQA (reduced window from 180 to 120 days), being compliance-ready is a full-time endeavor. Capline is the company that breathes and survives under these rules so that you never miss a deadline that could result in an abrupt "de-parting" of an insurance plan. It helps you achieve:

• Accuracy: Less chance of denied claims because of credentialing errors.
• Scalability: Easily add 1 or 10 providers without hiring new internal staff.
• Transparency: You have a dashboard to monitor real-time progress.

Challenges in Outsourcing Credentialing Services

Just as in any strategic partnership, there are certain obstacles that you have to take into consideration before entering into a contract.

1. Perceived Loss of Control

Outsourcing credentialing services takes control of the dental practice. Although the practice can benefit from their expertise, numerous details get neglected. The practice should ask the company to share regular updates on the status and ensure that the practice remains informed and engaged with the progress. This collaboration improves the quality of care without missing out on details.

2. Data Security Concerns

You are giving out very sensitive information like Social Security numbers, DEA licenses, and home addresses. Unless the outsourcing company has bank-grade encryption and high-level compliance with HIPAA, you are exposing your practice to a lot of risk.

3. Variable Costs

Although outsourcing is, in general, less expensive than the salary of a full-time coordinator (together with benefits), the expenses may accumulate in case of high turnover of the providers. You have to consider the per-provider fees or per-payer fees against your existing overhead.

How to Outsource to a Credentialing Company?

In case you find the above advantages satisfactory for your practice, then you should undertake the following steps to facilitate a smooth transition:

• Step 1: Conduct an Audit of Current Status: Know who is going to be re-credentialed within the next 6 months.
• Step 2: Clean Up Your CAQH. Having a clean start with your new partner, make sure your existing profiles are fully updated.
• Step 3: Define Your Scope. Do you require only the initial enrollment or maintenance and renewal of licenses?
• Step 4: Vet for Technology. Work only with those companies that have a digital portal to track statuses.

Which is the Best Credentialing Company?

You should look for a company that understands your specific specialty and state. You want a team that acts as a partner, not just a vendor. There are a lot of options available in the market: Symplr, VerityStream (HealthStream), and Verisys. But Capline Healthcare Management is the best credentialing company out there. You can contact us for your credentialing needs.

Conclusion

Deciding why to outsource your credentialing ultimately comes down to a choice between administrative control and operational efficiency.

Ready to reclaim your time? Fill out our contact form here to see how we can streamline your enrollment.

FAQs

1. Is outsourcing credentialing cheaper than hiring a full-time coordinator?

In almost every case, yes. In the US, a full-time credentialing coordinator may cost between 45,000 and 60,000 with benefits, but when outsourced, it may cost a small portion of that with the monthly fees or per provider.

2. What if the credentialing company makes mistakes on my CAQH profile?

A reputable company will have a quality-control layer whereby a top manager will scrutinize all entries and then submit them. In case of a mistake, you can ask for rework so that the mistake is rectified on the spot without any additional expenses.

3. Can I keep track of credentialing progress with an outsourced service?

Yes, the majority of the credentialing companies have an encrypted client portal. You can also log in at any point and keep track of the process.

4. Do credentialing companies guarantee approval with insurance carriers?

There are no companies that can guarantee a provider's acceptance by an insurance carrier, because panels may close sometimes. Nevertheless, they will ensure that the application will be 100 percent accurate and presented in the right channels to provide you with the best chances of success.

5. How do I know if my credentialing service is HIPAA compliant?

You are supposed to request from the company what their encryption levels are and if they are HIPAA compliant. 

6. How do I compare different credentialing outsourcing companies?

Pay particular attention to their experience in your specialty, their average turnaround time, and pricing transparency.