Dental credentialing is getting an insurance company to approve a dental practice to become a member of in-network providers. This can be done in-house or through a dental credentialing service company. When a dental practice gets credentialed, it gets access to a larger and newer patient base and a corresponding increase in revenue.
When credentialing is done, patients and insurance firms assume that the practice has a reputation and that processes are in order. The documentation needed for credentialing is quite significant. It consumes a lot of time for the dental team to put together. These details need to be submitted correctly for the credentials to get approved. If rejected, the team needs to resubmit the credentials and thus a lot more time gets spent to get credentialing completed.
Credentialing is paramount for dental practices because in case it is pending, the practice will not be reimbursed by the insurance company and the cash flows of the practice will be directly impacted.
A dental practice has a choice of getting credentialed with several insurance companies. However, the practice needs to get credentialed separately with each network you choose. This applies to all the dental practitioners within the practice. All of them need to be individually with the insurance company or the list of insurance companies as deemed fit by the practice.
It has been observed that a practice might bill an insurance company for services rendered to a patient by a new practitioner by using the credentials of existing practitioners who are already credentialed. This can be risky as the dental team might consider such a habit as a convenient way to pass claims for reimbursement.
This is slightly risky because based on how the claims are billed and submitted, there is a possibility that even inaccurate claims can get submitted. Government payers including Medicaid can consider such claims as fraudulent under different Acts and a dental practice may get bound by civil or even criminal laws.
Some ways how a dental credentialing service company can help a practice stay complaint are as follows:
The act of benevolence drives an obligation for dental practices to operate in the best interest of patients. The practice needs to prioritize patient care and welfare by offering solutions and treatments that maximize benefits while also curtailing possible harm or loss.
To uphold ethics and maintain integrity, the practice needs to stay updated on the latest developments in dental techniques and advancements. Such knowledge can help the practice to offer optimal treatment options for patients.
The practice can also provide specific treatment plans based on individual patient needs while taking into consideration elements like patient history and lifestyle. One needs to frequently monitor and assess treatment progress to ensure outcomes that are in line with patient expectations by paying close heed to patients’ needs, pain, or discomfort.
More importantly, the practice needs to engage with patients in a thorough discussion about treatment alternatives available and their associated benefits and risks. It can also seek the use of multimedia presentations or visual aids to help the patient acquire a clearer understanding of complex procedures and take consent for the same accordingly.
Patients can be encouraged to clear doubts and ask questions on all aspects of their treatment plan and all consented discussions can be documented with regards to the patient’s agreement for a selected treatment.
Audits are useful to measure the standard of patient care delivered against recommended standards. They act as a useful tool to gauge the quality of care and prompt remedial measures as needed for the practice to improve. Audits can work with full effect when standards have been re‐measured to demonstrate continual improvement. They need to be undertaken regularly as the dental practice can then assess standards of care and undertake necessary next steps.
There are also a lot of benefits when a dental practice undertakes a comprehensive audit. It can help to recognize areas that can positively drive efficiency, lower costs, and garner additional revenue. At the same time, it helps augment operational processes and makes the practice more efficient and effective.
A comprehensive audit also enhances profitability by identifying growth opportunities within the practice or even recognizing the potential for expanding services or an opportunity to open new locations. When dental practitioners across the practice are properly credentialed, they are more receptive and comfortable in managing audits and this enables the practice to stay compliant.
Credentialing offers manifold benefits and one of them is improved visibility. When the dental practice gets regularly credentialed, it gets listed in multiple databases and directories that patients and other healthcare providers can have access to. This acts as a lead-generation tool to help the practice seek wider audiences and attract new patients. A practice that is credentialed can stand out from its competitors and make a name for itself as a reliable and trustworthy dental care provider.
One more benefit that credentialing offers is greater credibility. On undergoing the credentialing process, a dental practice affirms its commitment to maintaining high standards of professionalism and dental care. This in turn fosters trust and confidence among patients, partners, and insurance firms. As a result, the dental practice can benefit from a greater number of referrals and patient streams. It can also augment partnerships with other dental care providers and increase the reach and reputation of the practice.
When the dental team is credentialed, it can deliver better quality care and service. This leads to higher patient satisfaction and health outcomes. Such satisfaction can drive repeat visits and a patient is more likely to recommend other patients while continuing suggested treatment regimens and regular checkups.
Multiple research observations suggest that dental practices where the team is credentialed can significantly boost health outcomes and patient satisfaction thereby increasing ratings and perceived competency.
Dental credentialing is an assurance that dental practitioners confirm the minimal criteria mandated for capability and competency. It curtails the chance of care and service being delivered by underqualified professionals as this can lead to clinical errors, hurt patients, and create legal liabilities.
Thus, credentialing helps mitigate risk and helps the practice stay compliant by making sure that the practice does not employ unlicensed or underqualified dental professionals. This lowers the chance of malpractice lawsuits being filed against the practice and safeguards its reputation.
Dental practices are governed by laws and regulations from states, federal bodies, and insurance firms. Credentialing ensures that a dental practice fulfills obligations set by such bodies and protects it from audits and penalties arising out of non-compliance.
It thus reduces legal exposure by maintaining required documentation and all requirements of insurance companies are met during claim processing and reimbursement.
While credentialing can be a primary requisite for a dental practice to get reimbursed, a practice also benefits by staying compliant as needed by regulatory bodies as well as earning the goodwill of its patients. It also speeds up reimbursement by insurance companies which in turn impacts cash flows.
