How Mistakes in Credentialing Affect Revenue

Before any reimbursements or payments from different payers, a number of requirements must meet by all parties, including the patient, the practitioner, and the payer. As it is clear in the contract, this. One of these requirements is the doctor’s credentialing, which your office should complete or the medical billing company where the doctor works.

Although the particular need of medical credentialing services is simple in theory, it is significantly more difficult to implement in practice. So much so that mistakes made during the credentialing process cost the healthcare sector $1 billion annually. You should investigate your practice’s credentialing procedure and perhaps think about outsourcing it if you want to prevent your practice’s funds from falling into that amount.

What does credentialing mean?

Credentialing is the process of confirming the legitimacy of a physician’s degree, education, and training. The procedure’ primary goal is to provide a bridge between local legislation and the medical field, ensuring that all clinics and medical institutions are abiding by the law while providing medical care. A payer can determine a physician’s validity through credentialing, resulting in correct patient treatment and payment.

Credentialing has advantages for patients as well as doctors because it ensures that the doctor is competent in what they are doing. Patients obtain the best healthcare possible from licensed, trained specialists in this way.

Credentialing mistakes and revenue

Credentialing is not a simple task that, even if done incorrectly, won’t cause a significant setback based on its description. Nothing could be further from the truth than that. Errors in credentialing or a lack of credentialing immediately affect your practice’s ability for validation by the payer, which fully stops reimbursements. When your firm is already rendering the service, not being reimbursed might be even more expensive. That would be a significant damage to your revenue cycle and might be bad for your practice as a whole.

Mistakes in credentials have a negative impact on patient retention, which impacts revenue. Patients are less inclined to trust doctors in your clinic if you can’t confirm their educational backgrounds and medical degrees. They have a higher propensity to cancel their appointment or never show up at the office again, both of which will eventually harm your practice.

4 credentialing mistakes that your practice can be making

Credentialing errors happen in all practices, but if you’re willing to address them and discover a workable solution, you’re already one step ahead of the competition. These are the major errors that most practices commit, so you need to watch out for them. These specific errors are not necessary. Even though the errors at your office could differ from these examples, they are nonetheless possible issues that  must go under consideration.

1.    Starting the credentialing process quickly

Timing is crucial for the credentialing process, just like it is for everything else in medicine. Credentialing normally takes three to four months to complete, though the exact time frame is likely to vary from provider to provider. This makes sense that the size of the data set that needs for confirmation and process. Prior to providing services, your firm must provide the payers ample time to finish the process.

2.    CAQH failure

The Council for Affordable Quality Healthcare Inc., a non-profit organization based in California, serves as an online repository for all physician certification information. It is essential to maintain the data current because insurance carriers have access to it through CAQH. To prevent data loss, your team should take the effort to re-attest the profiles as soon as possible.

3.    Unverified information

Credentialing denials may be caused by incomplete or erroneous information, such as inaccuracies in minor things like the doctor’s email address or inaccurate evidence. These can be detrimental to the verification procedure because not all accurate information is available for judging the credibility of the doctor. This will impede the credentialing process, which is a time when a doctor cannot provide any services and cannot make payments for those services.

4.    Your administrative personnel did not follow up

Payers are getting numerous requests for verification from various hospitals and medical facilities. There is a tone of documentation and data that goes along with every request, all of which needs tremendous be processed in detail. It wouldn’t be unexpected if your application got lost in the sea of information, and if your employees didn’t follow up on it, nobody would know where it stood.

Keep visiting for more articles related to medical billing and coding.

Jesse handerson

I am a professional blogger at a renowned medical billing company. I used to write quality blogs and articles related to medical billing company and practice management etc.

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