Offering quality medical services without compromise to their patients is the main motive of each physician. Patients choose to return and receive medical-related services based on the quality of medical care or change and opt for a better physician.
A well-experienced and expertly trained physician can only offer high-quality services to the patient. Provider credentialing services ensure their merit gets attested. Whenever a medical practitioner joins a hospital, physician credentialing is done, which is a process by which the validation of providers gets done for their educational qualification, certification, complete work history and conduct while rendering medical care and treatment. The exact process, re-credentialing, is repeated each year.
Through the process of privileging, the physician gets authorized to offer a specific scope of medical service based on their credentials. Since these complex processes are tedious and time-consuming, it affects the regular function of medical billing companies and strains their revenue cycle. Streamlining the physician credentialing process allows medical billing companies to operate seamlessly and remain successful.
Here are six steps to streamline Physician Credentialing Process:
1. Create a checklist and digitalize payor enrollment:
There is a whole set of complex and vital requirements for Payor enrollment. Depending on the place, these prerequisites might differ, making it more strenuous for healthcare providers. By creating an exhaustive checklist of all the necessary documents and forms, the process of payor enrollment must begin the moment you onboard a new provider. Simultaneously, ensure to digitalize the payor enrollment as it would be of great assistance to the medical practitioners to be sure of the requirements for them to get a quicker enrollment. By doing so, you can avoid unnecessary delays, and the applications move faster.
2. Ensure to record accurate data:
The data recorded in the medical billing company's provider credentialing system and the Payer credentialing system must be the same. The revenue gets strained eventually, in case both data do not match. It is essential to carefully check the provider's background information before recording the data into the physician credentialing system.
3. Choice of appropriate Insurance plans and Networks
With the many health insurance plans and networks available, choosing an appropriate one could be perplexing. Various factors get evaluated before making a clear decision. It is one of the crucial steps in the process of payor enrollment since the healthcare providers' reimbursements received for the rendered medical service is drastically influenced. By choosing an inappropriate insurance network, other than the reimbursement rates, the workflow of the entire practice is considerably affected. If you prefer to enjoy a seamless and healthy flow of revenue, you should ensure that the practitioners enroll with the appropriate insurance networks.
4. Automate to enhance functions and regularly follow-up:
The traditional way of recording data will further delay the cumbersomeprocess of physician credentialing. Hence it is best to enhance the functions using the latest and most advanced automated systems. Even the most crucial tasks in the credentialing process get automated and effortlessly send reminders requesting to submit the applications on time. Also, ensure to monitor the insurance companies as soon as the provider credentialing process gets initiated. The application status gets clear when you follow up regularly and quickens the process.
5. Always Track and Keep Reporting:
You can improve the physician credentialing process by implementing best practices of which tracking and reporting are crucial practices. It is vital to track the provider enrollment days, the processing times for the provider and the departments, and the multiple payers' rules. The higher authorities must receive a weekly or monthly report for review along with the tracked data. A thorough check of the report is essential, and you need to ensure that the necessary steps are taken for areas where improvement is required.
6. Outsource to quicken the process and drive healthy revenue:
Mainly the tedious functions of medical billing burden the medical billing companies, and they tend to overlook provider credentialing services and lack in streamlining the significant credentialing process. At the same time, offshore medical billing companies have advanced data systems and cloud-based software to improve the physician credentialing process. Their team contains highly experienced and well-trained experts to render error-free credentialing. And the most critical point to note is that they offer quick turn-around times and drive healthy revenue at minimum costs.