Common Credentialing Mistakes That Can Make Your Finances Go Awry

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May 15, 2023

Common Credentialing Mistakes That Can Make Your Finances Go Awry

Medical credentialing is something crucial, but often an overlooked and ignored aspect within the healthcare industry. Basically, anyone involved in patient care is required to undergo a process of verifying their credentials. Well, what does that mean? It’s simply that they must prove they have the appropriate education, training, skills, and clinical competencies needed to duly care for patients. Credentialing is necessary before a physician can care for patients and to become enlisted with insurance companies. Simply put, without proper credentialing a physician is not entitled to legally work or partner with insurance companies. So, from a financial perspective, without receiving the credential as a listed service provider a healthcare practitioner cannot receive reimbursements for provided services from the insurance companies. And, lack of reimbursements is a huge hit to their revenue cycle and detrimental to the overall financial health of their practice.

What does credentialing cover?

Well, credentialing covers medical credentialing, privileging and enrolment.

Medical credentialing is assessing and verifying if the physician has the required education, training, and licensure to provide healthcare services.

Privileging involves getting the approval to treat and perform certain procedures.

Enrolment is being credentialed by insurance companies for successful inclusion into their panels.

Credentialing mistakes that can cost your practice

Medical credentialing is a complex, detail-oriented, tiring task and is often prone to errors and redundancies. It can even cost you thousands of dollars if you don't get it right. More intensely, credentialing mistakes can leave you vulnerable to malpractice lawsuits, fines, and penalties. Let us see some of the common credentialing mistakes that most practices frequently make which impair their efficiency and revenue stream.

Mistakes with timing and planning

Credentialing for any physician requires a great degree of planning and a fairly long lead time. Typically, the credentialing process takes somewhere between 90 to 120 days. From filling out the application form to organizing all the medical documents in a file – every step requires meticulous care and patience as it will take the longest. For a physician, delay means they can’t get started on seeing patients. This could mean that they will lose thousands of dollars or even more in lost income. It is the responsibility of every physician to plan ahead of time, initiate the credentialing process and complete it within the time frame to avoid lost revenue. Lack of proper planning will only result in waiting times that are longer than expected.

Mistakes with accuracy and completeness

One of the intimidating aspects of medical credentialing is filling out the application form. The number of pages can be anywhere between 3 and 300, depending on the physician's specialization. Utmost care should be taken to ensure the accuracy and completeness of the information given. Even a typo or involuntary miss can lead to delays or rework of the credentialing process. In short, any data entry errors will ultimately impact the timeline and cash flow to the practice.

Mistakes with compliance

Each state in the US has different credentialing requirements. Even the rules and regulations about the credentialing process vary from state to state. And it so happens that physicians or incompetent staff, oftentimes fail to comply with them. Sometimes the staff tasked with credentialing may screw things up due to sheer ignorance of the insurance provider’s standard regulations. Moreover, the credentialing and enrollment process differ among payers. Failing to meet the requirements can result in payment delays and impact financial stability. Similarly, not having enough experience or knowledge in differentiating different specialties could result in compliance mistakes. Also, if the medical practice staff is unaware of the legal implications of non-compliance it can result in legal liability if things go wrong.

Mistakes in the enrolment process

The enrolment process is linked with the billing and payment process. So, in case of any mistakes in the enrolment process it is likely to bring down the efficiency of the revenue cycle.

Every insurance provider has a predefined set of rules, regulations and protocols that needs to be followed for adding new physicians to its panel. Failing to comply with requirements is one reason for credentialing mistakes. Similarly, not being familiar with local insurance providers is yet another frequent mistake that happens in the credentialing process. More so, not having a dedicated staff to answer the queries and questions that the insurance company may have can delay the payment process and result in a revenue loss.

Mistakes due to lack of help from experts

We are aware that insurance credentialing or provider enrollment has evolved over the years and has become more complex and difficult to deal with. There are high chances that things could go wrong if this is done internally. Making your staff deal with time-consuming, excessive paperwork makes them lose valuable time that could have otherwise been spent on patient care activities. They also lack the necessary skillset and expertise to effectively manage the entire credentialing process. It is also crucial for medical practices to ensure that every staff member complies with the credentialing requirements. This can be achieved only if they are familiar with the laws that govern the credentialing process. A failure to do so, could result in serious consequences like hefty fines, denied or delayed reimbursements and ultimately revenue loss and reputation. That is why it is important to outsource your credentialing services.

Credentialing experts like Scribe4Me can help streamline the entire credentialing process and ensure a hassle-free experience. Yes, Scribe4Me can work with you as your reliable credentialing partner and help you save a lot of time and money that could be devoted to patient care. Our credentialing specialists are experts who stay focused on ensuring an efficient and error-free credentialing process. To learn more on how Scribe4Me‘s credentialing services can help your practice perform better reach us at (908)7608935 or email us at [email protected].

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