Physician credentialing remains a big, blind spot for group practices. Non-credentialed providers add another layer of complexity to the fragmented and convoluted revenue cycle of group practices.
Studies reveal that more than 25 hours are spent on the credentialing process per provider. And a single physician takes more than 40 hours to handle his/her enrolment process. High days in enrolment, is another major issue faced by group practices.
The costs and time associated with credentialing, drive group practices round the bend.
But credentialing is a necessary evil. It is not just a simple, inconsequential form you fill out and forget about. The varied credentialing processes followed by insurers, critical deadlines and the uncertainties surrounding the system make it mission critical for group practices.
A slipshod credentialing process will result in…
- Unrecovered revenue
- Delayed or denied payments
- Compliance issues
- Strained payer-provider relationship
- AR backlogs
Oops, that’s a lot of money!
Here is a ballpark figure of the credentialing costs for a multi-specialty group consisting of 10 physicians.
| Initial cost of establishing the group’s physician credentialing file | $350.00 |
| Initial cost of setting up the nurse practitioners credentialing file | $250.00 |
| The cost of mapping to the physician state uniform app | $100.00 |
| The cost of mapping to the state uniform app of nurse practitioners | $100.00 |
| Initial credentialing charges for 10 physicians at $150 each | $1,500.00 |
| Credentialing cost of 4 NPs at 145 dollars each | $580 |
| License costs | $190.00 |
| Total credentialing cost | $2970 |
With the high costs involved in the credentialing process it definitely makes sense to rework existing procedures, to more streamlined ones, to survive in the present-day healthcare space.
Red flags you shouldn’t miss…
The top credentialing problem in group practices is information errors during the credentialing process. As several physicians are involved, loss or mismanagement of information is de rigueur. Breaks in service that are not accounted for can severely handicap the credentialing process. And, so do, gaps in insurance coverage.
Physicians who have neutral reference letters can also dampen the credentialing procedure. The increase in on-boarding provider volumes in today’s environment of acquisitions has made it imperative, to have an efficient credentialing management process in place. A thorough verification and background checking process while adding a new physician to the group will reduce information errors and credentialing bottlenecks in the long run.
Follow these strategies to ensure timely and successful credentialing at your group practice…
Here we described a practically successful workflow to offer flawless credentialing solutions for your group practices. You can download the step by step credentialing guide here.
- Not just the credentials of the individual provider who needs to be credentialed include the details of every physician listed on the CAQH roster and your group agreement during the credentialing process.
- Furnish the contact details of the practice manager or group administrator of your practice.
- If there is a single point of contact for the all providers in your group practice mention it in the form.
- While credentialing a new physician candidate link the start-date of the provider to the paperwork submission.
- In case of a change in your group name fill out and submit the updated W-9 form to the payer.
- Understand that the credentialing process differs across different states. Follow state specific regulations.
- Include accurate and updated mailing addresses credentialing details and all other important communication reach the appropriate recipient.
- Use the Q-6 modifier to bill new providers who’ve joined your group as locum tenens. But some health plans do not accept this method. Thoroughly scrutinize the insurer’s regulations prior to billing a new provider as locum tenens.
- Make sure that the health care providers joining your group practice complete the Universal Credentialing DataSource credentialing application (UCD).
- Ensure that every provider in the group re-credentials within stipulated deadlines to avoid cancellation of privileges.
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