How Credentialing Mistakes Affect Revenue and How Practices Can Avoid Them?

Medical credentialing is a crucial step in making your medical practice a success down the road. It verifies that your healthcare providers are trained and certified and also have the professional experience to offer their services in the best way possible.

However, it may be a cumbersome task for most healthcare organizations as you need to deal with the filing of documents, gathering the required info, following up, etc. But it also is essential for a healthy revenue stream. Hence, you can always outsource this process by leveraging medical billing and credentialing services. Although plenty of companies offer such services, you can check out their website and make an informed decision based on their experience and reviews.

If you’re on the hunt for the impact of credentialing mistakes on your revenue and how you can avoid them, keep reading this article!

1.   Not Planning Enough Time

Not planning enough time is one of the most common mistakes that also drastically affects revenue. It’s vital to know that when you hire a new medical practitioner, you must verify them with the payers such as Medicare and Medicaid.

You need to allow the entire process at least 3 months. However, if you still hire a healthcare practitioner and they aren’t verified, the payers won’t reimburse you. Moreover, the patients won’t trust them enough without verification to get treated by them.

Therefore, you must immediately start the verification process whenever you’re planning to have a new practitioner onboard. This will give you enough time to verify them by the payers while they officially start working at the healthcare facility.

2.   Providing Inaccurate or Incomplete Info

Most entities want to get rid of the process as soon as possible. However, providing inaccurate or incomplete information would lead to delays or, in the worst-case scenario, denial.

Having to resubmit all the required documents with accurate info would need you another 3 months at the minimum. During this period, you will lose potential patients while you could have earned more.  

Thus, it’s always better to be vigilant at first and double-check all the documents you’re submitting. While filling out applications, you must make sure that you’re entering accurate data such as the name, address, etc.

3.   Lack of Follow-Up

Not following up with the payers after you have submitted the applications will work against you. Having to wait for a notice from the payers for re-credentialing can waste your time and money.

Therefore, you should keep a check on the application status, and staying in contact with them will allow you to stay updated with the process. If anything needs to be amended, you will be able to do that quickly instead of waiting for the payer’s notice.

Furthermore, you should also keep in mind that some payers may not update you on the process at all. That’s when you should step in and stay in touch with them.

4.   Not Allocating Trained Staff

If you don’t have the time to handle the process yourself or your staff is not competent enough to deal with credentialing procedures every time you hire a new healthcare provider, it will significantly affect your bottom line.

What you can do is hire experienced personnel from a well-reputed medical billing company. They will handle everything for you to ensure your peace of mind and boost your overall revenue.