Why Outsource Your Credentialing?

Let’s be real – dealing with credentialing is difficult. No healthcare organization truly wants to maintain or balance it. It’s tedious, time-consuming, and can feel like an endless loop of paperwork and verification. But here’s the thing – it’s absolutely crucial. Proper credentialing ensures that your practitioners are qualified and up-to-date, allowing them to get paid for their hard work. It’s also mandated by regulatory bodies to protect patient safety.

So while credentialing may not be the most glamorous part of running a healthcare business, it’s 100% necessary. The question then becomes – do you really want your team spending countless hours on this administrative burden? Or would it be better to hand it off to credentialing experts so you can focus on your core mission of providing excellent patient care?

If you’re on the fence about outsourcing your credentialing, this guide is for you. We’ll cover all the reasons why outsourcing just makes sense, from cost savings to organizational efficiency. Let’s dive in!

Reason #1: You’ll Save a Ton of Time and Headaches

Credentialing is ridiculously time intensive when done in-house.

Keeping on top of all this is a full-time job in itself. And if anything slips through the cracks, it can lead to costly reimbursement delays or even payers terminating practitioners from their networks.

When you outsource to a credentialing company, all of those headaches get lifted off your plate. Their whole business is streamlining and managing this process from start to finish. You get teams of credentialing experts doing this all day, every day while following rigorous quality control.

No more lost paperwork, missed deadlines, or improvising your way through confusing payer protocols. They know all the ins and outs, allowing your medical staff to stay focused on their primary mission of treating patients.

Reason #2: Lower Overhead Costs and Compliance Risks

The average healthcare provider spends over $800,000 per year on provider credentialing according to industry surveys.

Most credentialing companies can do it for a fraction of those costs through economies of scale and workflow optimizations. Their whole model is built around maximizing efficiency.

Then there’s the reduced risk of costly compliance penalties or litigation issues. Credentialing criteria gets more complex every year as regulations evolve. It’s easy for an in-house team to make mistakes or miss obscure requirements given how convoluted the process is.

Credentialing vendors live and breathe this world. They employ experts who stay on top of all the latest NCQA, CMS, URAC, and state/federal rules. This gives you an extra layer of protection against potential lawsuits or violations that can lead to hefty fines.

Reason #3: Improved Turnaround Times and Increased Revenue

Effective credentialing is all about speed and accuracy in today’s fast-moving healthcare ecosystem. Every day a practitioner’s credentials are delayed directly impacts your ability to see patients and get paid.

Using archaic manual processes virtually guarantees slowdowns compared to a dedicated credentialing service. Their technologies and workflow automations are finely tuned to accelerate every step. From electronic document collection to credentialing process management software, they leverage the latest tools to blitz through applications rapidly.

The end result? Shorter committees and turnaround times to get practitioners fully credentialed and billing. Those revenue cycles start flowing faster and more consistently.

Case studies show that organizations see 25-40% improvements in credentialing speeds after outsourcing. For a large practice or health system, that can translate into millions of dollars in extra revenue simply from streamlining the process.

Reason #4: Scale Up or Down Effortlessly

One of the biggest logistical challenges with in-house credentialing is having to quickly ramp up staffing during busy periods or downsize during slower stretches.

Neither scenario is ideal. Getting hit with emergency overflow can lead to mistakes and major delays. But then you’re stuck paying the salaries and benefits of a bloated department during calmer periods.

Outsourced credentialing partners simply adapt to your fluctuating needs. They’ve built processes to add more staff and prioritize your workload during busy times like expansion or revalidation periods.

When things slow down, you’re not carrying that excess labor expense. The service seamlessly downsizes to fit your current volume while still meeting all timelines. It’s a plug-and-play staffing model that maps to your exact needs without waste.

Reason #5: Eliminate Hiring and Training Headaches

Assembling and retaining an effective in-house team is a massive challenge in today’s job market. The unemployment rate for credentialing specialists hovers around 2%. That means top candidates have their pick of jobs and tend to chase the highest salaries.

It’s a never-ending cycle of recruiting, hiring, and then re-hiring after employees leave for “greener pastures.” All while bearing the costs of employment taxes, health benefits, office space, and other overhead.

Outsourcing partners handle all of that. You get access to a deep bench of experienced credentialing pros, but without any of the hiring frenzy or exorbitant labor costs. They invest in stringent recruitment and ongoing training so you don’t have to.

And if an employee leaves, it’s their problem to backfill the role swiftly. No scrambling on your end or lowered production while trying to refill the gap.

Reason #6: Maximize Portability and Consolidation

Healthcare is constantly evolving with frequent practice acquisitions, mergers, network expansions into new states, and selling off business units. Each of those transitions creates a labyrinth of credentialing challenges as providers move between different facilities, locations, and payer networks.

An in-house team often struggles to manage that portability and consolidation effectively. Every time a practitioner shifts to a new setting or payer, it triggers a whole new credentialing process from scratch. Keeping everything coordinated and up-to-date is like herding cats.

Outsourced credentialing partners have this down to a science. Their job is making those corporate transitions seamless, taking the full credentials file and getting providers re-credentialed in their new environment ASAP. That’s especially important during high-value events like practice mergers where any delays can severely impact revenue streams.

Instead of a fragmented, ad-hoc approach, they deploy proven processes and dedicated team members to streamline multi-site, multi-state transitions from end-to-end.

Reason #7: Gain Better Visibility and Transparency

When dealing with in-house credentialing, visibility is often lacking.

The process exists in silos, trapped within manual spreadsheets or outdated software that only the credentialing team has access to. Reporting is limited and it requires nagging the overloaded credentialing staff to get simple status updates.

Modern credentialing partners operate on centralized platforms that give you a real-time window into every aspect. Through secure web portals, you can check credentialing status for your entire roster of practitioners at any given moment. Automated reporting flags issues that require attention with full audit trails.

There’s no more stabbing in the dark – just full transparency and insights to drive higher accountability.

Reason #8: Bolster Security and HIPAA Compliance

Healthcare organizations are massive targets for cyber criminals looking to steal sensitive data like medical records, personally identifiable information (PII), payment details, and more. The credential files for providers are a goldmine that needs to be properly safeguarded per HIPAA rules.

Generally, it’s extremely difficult and expensive for midsize or smaller practices to achieve best-in-class data security. Law firms and Big Tech companies spend millions on cybersecurity tools and protocols. Most healthcare providers don’t have those kinds of budgets.