How Credentialing Inefficiencies Cost Your Practice Thousands

With Healthcare reimbursement dropping and practice costs increasing, Healthcare practices are often compelled to evaluate various cost reduction strategies. Rather than just looking at ways to cut costs, this article would like to suggest that practices should consider ways to improve existing procedures and processes as well. It isn’t easy or advisable to reduce costs on the patient care side, so practices are obliged to consider ways to reduce administrative and overhead costs.

DoctorsManagement’s Consultants specialize in Medical Practice Management and can offer a myriad of solutions to effectively and efficiently manage administrative and operational tasks by performing a practice assessment, however, this article would like to focus specifically on the area of credentialing.

Credentialing inefficiencies can cause thousands of dollars in lost revenue per physician. It is estimated that inefficient credentialing costs the healthcare industry over $2 billion annually, with delays causing approximately $9,000 in lost revenue per provider, per day. A 3-month delay in credentialing a new physician can result in over $100,000 of lost revenue. A single provider missing 12 weeks of patient visits can cost a practice, while specialists or surgeons may lose over a 120-day delay. Those losses add up quickly.

Common results of credentialing inefficiencies are:

• Revenue loss due to services that cannot be billed
• Higher claim denial rates
• Cash flow disruption
• Costs of administrative rework

The few common reasons for credentialing inefficiency could be:

Manual Processes

While we recognize that most credentialing software systems may not be in the budget for many small practices and have limitations, there may be other ways available to streamline the process. Something as simple as using MS Forms and MS 365 Agents to help collect and organize credentialing onboarding information can assist in reducing data entry error mistakes as well as improving data collection times.

Fragmented Systems or Processes

Many health systems rely on four or more systems to manage provider onboarding workflows, leading to duplicative effort, lost time, and limited visibility (Kaufman Hall).

Having multiple systems in place in a small practice is probably not typical, however, it is still important that credentialing processes be streamlined and consolidated. Creating a list of standard credentialing onboarding processes and procedures can improve workflows and reduce duplicative efforts.

Some top suggestions to get started would be:

• Use a standardized onboarding application for every provider
• Standardize onboarding task tracking and management
• Create a standardized filing system for storage of credentialing onboarding information, documentation, applications, contracts and correspondence
• Create a standardized follow up schedule for status updates

Payor Complexity

Requirements differ for each payor and a lack of knowledge regarding each payor’s unique requirements and timelines can lead to delays and application rejection. Evolving requirements and processes from payors often slow down the process. In an effort to stay abreast of technological advances and reducing credentialing administrative burdens often caused by staffing shortages, healthcare payors often update their credentialing processes and it is important for credentialing experts to stay abreast of various payor updates.

Provider Credentialing and Enrollment is an ever-changing process that challenges even the best credentialing teams. Medical credentialing services can institute organization, accountability and knowledge to a complex process. Outsourcing credentialing services to an organization with the tools, skills and knowledge to complete the credentialing process correctly can reduce the burden placed on the practice caused by inefficient practices. DoctorsManagement’s credentialing staff have extensive knowledge, experience and tools to successfully complete the credentialing process. If your organization needs assistance with credentialing and onboarding, whether it be with new practice startups, existing practices adding new providers, or credentialing maintenance, DoctorsManagement is here to assist.