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Reasons to Outsource Medical Credentialing

Learn the definition of Medical Credentialing, two types, and five main reasons why it is outsourced to a Billing company.

In today’s evolving landscape of the healthcare industry, medical credentialing is the key factor that is frequently outsourced. Many healthcare facilities cannot handle the intricate process of credentialing effectively. In this blog, you will learn about the basics of medical credentialing, their types, and the main reason why it is outsourced.

The ABC of Medical Credentialing

Medical credentialing, provider credentialing, and healthcare credentialing are different names for the same process of credentialing. It is the process of evaluating everything related to the provider. This includes educational verification, practice licenses, professional experiences, and training.

Through this verification, it is determined that the healthcare providers are properly qualified and have the expertise to deliver healthcare duties. In this way, the quality and safety of healthcare services is maintained.

2 Types of Medical Credentialing

The two basic types of credentialing are:

  • Onboarding Credentialing  (Physician Credentialing)
  • Payor

In onboarding credentialing, providers’ information, such as educational background, practice license, certifications, and professional career, is checked in full depth. Whereas, in payer credentialing, it is ensured that the provider has fulfilled all the guidelines and is compliant with the rules and regulations of the insurance company.

5 Reasons to Outsource Medical Credentialing

Medical Credentialing itself is time-consuming and requires months for its completion. so, many healthcare facilities find it easy to outsource credentialing and focus entirely on the patient’s treatment. Here are some of the key reasons why healthcare providers outsource credentialing:

Expert team for the Verification of Provider’s Documents

Specialized credentialing companies like MedHeave have a team of skilled experts who verify the credibility of the provider. The team understands the complex process of credentialing and thus verifies the provider’s educational documents and all other certifications in a better and error-free manner. They have automated software that reduces the common errors that used to happen when it was done manually.

Lowers Administrative Burden

Credentialing is a very complex process that requires several steps to complete. This includes data entry, application processing, record maintenance, and license verification. Outsourcing this intricate process reduces the administrative burden and ensures that all documents are authentic and up-to-date.

Turnaround Time

Medical Credentialing is effective when it shows both accuracy and rapidity. This is possible when there is a dedicated team only devoted to the task of credentialing and free from any side projects. An in-house credentialing system needs weeks to manually sort through the papers, spreadsheets, and databases involved in credentialing. Thus, outsourcing ensures a quicker turnaround time, and everyone benefits when turnaround times are sped up.

Reduces Operating Cost

Operation costs can be minimized by outsourcing medical credentialing. There is no need for healthcare businesses to hire and maintain an internal team devoted to this complex and labor-intensive procedure. Healthcare facilities don’t need to provide salaries to the special staff assigned for the credentialing process. This economic strategy enables them to refocus financial resources on essential healthcare services, thereby enhancing the effectiveness and viability of their business.

Ensure Compliance

Medical credentialing companies are highly compliant with the updated guidelines of insurance companies. They have up-to-date knowledge of the latest requirements for accrediting organizations and state licensing boards. When a credentialing specialist team handles the whole process, there is no chance of compliance-related errors. This helps the company by protecting it from legal penalties and fines.

Final Words

In-house credentialing is not only time-consuming but also demands laborious efforts and money. Outsourcing medical credentialing to a well-reputed billing and coding company not only helps the facility save time and money but also the onboarding efforts.

Written By

MedHeave is a medical billing company that provides services to healthcare providers, such as physicians, hospitals, and clinics.

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