The famous Chinese philosopher Confucius once said, "A man who does not plan long ahead will find trouble at his door." This is true, especially with healthcare providers in the U.S. and their physician credentialing process.
In a study conducted and published by the Beckers Hospital Review, it has been revealed that a one month delay in physician credentialing can result in a $30,000 loss in revenue. This amount further increases for higher billing specialties such as cardiothoracic surgery and orthopedics. Thus, it is important for healthcare providers to plan properly for their physician credentialing procedure to ensure their cash flow will run smoothly in 2019.
These steps will help you organize your physician credentialing process:
Step 1: Start Early
Physicians Practice, an online publication, said that most physician credentialing can be done within 50 to 90 days, but it is best to give your practice a 120-day leeway. This is because the internal timeline of the payer who processes the application varies, differing from one payer to another.
Given this timeframe, it is best to start your physician credentialing process earlier, preferably prior to hiring.
Step 2: Pay Attention to Detail
Perform the necessary due diligence when submitting your application.
Many physician credentialing delays are caused by incomplete and incorrect information. This is a simple mistake that can cost you a huge sum of money. Thus, it is important for your team handling the physician credentialing process to pay close attention to all of the required information.
Double check to see if all of the entries have been properly filled out. In doing so, you'll have a more efficient physician credentialing process, which means completing it within 50 to 90 days. Plus, you avoid going through the process of re-applying.
Step 3: Remain Updated with the Coalition for Affordable Quality Healthcare (CAQH)
In December 2018, CAQH announced new functionality for Verifide ™, This automated solution verifies the accuracy and completeness of credentialing information submitted by healthcare providers to health plans.
This will now become the primary source verification (PSV) as it offers real-time visibility into your credentialing application status. As a result, your practice will have an easier time knowing the reason behind your physician credentialing rejection or denial.
Thus, you should always be in the loop with the latest updates provided by CAQH.
Step 4: Be Knowledgeable with State Regulations
State regulations vary from one another. For some states, a physician credentialed by Provider A in another state may be streamlined in their states; others may allow a physician to avoid the full credentialing process again when moving from one practice to another within the same state.
Just take a look at Texas. A credential verification organization has been launched through the collaboration of Texas Medical Association and 19 Medicaid health insurance plans. The organization’s goal is to reduce paperwork for Texas physicians.
Amanda Hudgens, director of special projects for The Texas Credentialing Alliance (TAHP), stated:
"We want to simplify the credentialing process for physicians here in Texas and we're focusing on Medicaid providers because we understand they have a lot of paperwork burdens and administrative requirements to become a Medicaid provider."
Thus, it is important for the one handling your physician credentialing to know all about these varying state regulations.
The physician credentialing process remains a tedious process if you do not have all the information you need up front. Following the above recommendations will help speed up this process while eliminating inefficiencies.
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ClaimCare helps new medical practices and existing organizations with their physician credentialing process. They even assist in training your front desk office staff for a more efficient medical billing process. Learn more.