In this article we’ll take a minute and look at the importance of credentialing and how it could cost you thousands and quite literally put you out of business. Credentialing/Insurance Enrollment refers to, the time-consuming, delay-filled, frustration-generating necessity, and is often the last thing on a physician’s mind when running a practice. Unfortunately, it is often overlooked by your staff, it could literally be the death sentence of your practice.
Credentialing, therefore, is quite important. It stands at the starting gate of the reimbursement race. In simple terms credentialing exists to vet healthcare providers. When done wrong or not done right away, it costs deeply. Credentialing errors and delays will cost thousands of dollars or much more.
The Ripple Effect of One Revalidation Failure
A single rejected, or missed, recredentialed application could result in thousands of unpaid claims. How many patients does one healthcare provider see each day? In a week? During the month? What is their average billing for each of these patient interactions? Now imagine having every one of these claims rejected because of a revalidation error or recredentialing oversight. Each related claim will be placed on hold until the revalidation is completed. This delays reimbursement. Then each claim must be resubmitted. More reimbursement delays. The more time that passes after seeing the patient, the greater the likelihood some event will cause the claim to be denied. More delays and some denials, all because credentialing was at the bottom of the stack instead of on top of it.
An Expensive Scribe
A new hire who can’t see patients because of credentialing is about as valuable as a scribe. For a new physician expect the credentialing to take at least 120 days, and a month or so longer for a graduating resident or fellow. That’s four to five months of payroll costs for an expensive employee without the benefit of incoming revenue to offset it. Each delay in gathering information, submitting it, and needing to correct errors, serves to push the timetable back even more. Though I suppose the doctor in question could see cash-only patients, how many of those are there?
Rejected Claims Spike
Denials skyrocket because of participation issues. When a physician’s status is in question because of credentialing or recredentialing, the response to claims can vary. The most likely result is a huge jump in denied claims. Minimize this by handling all credentialing or recredentialing in a timely, accurate, and proficient manner.
With so much at stake regarding credentialing and recredentialing, each error, delay, or misstep has profound financial ramifications that damages the healthcare organization’s bottom line and threatens its very viability. Don’t risk this critical step by turning it over to well-meaning staff who try their best but often encounter unexpected problems or are simply stretched in too many directions.
Instead turn it over to experts who specialize in credentialing and provider insurance enrollment, and do it every day throughout the year for thousands of healthcare professionals around the country. You’ll be doing yourself and your organization a huge favor.