Typically, the healthcare industry moves at lightning speed, but credentialing processes often crawl along at a snail’s pace. This creates a frustrating dilemma for healthcare providers eager to start seeing patients and generating revenue. The burning question remains… Can providers treat patients while their credentialing applications are still working their way through the system?
The short answer is yes, but it comes with important caveats, restrictions, and strategic considerations that every healthcare provider needs to know. Let’s dive into the specifics of what’s possible, what’s risky, and how to make smart decisions during this waiting period.
The Reality of Credentialing Timelines
Healthcare credentialing is notorious for its lengthy timelines. Most insurance companies take anywhere from 90 to 180 days to complete the credentialing process, with some taking even longer. Medicare credentialing through the Provider Enrollment, Chain, and Ownership System (PECOS) can stretch beyond six months in many cases.
These delays aren’t just bureaucratic inconveniences, they represent real financial challenges for healthcare practices. New providers joining established practices face income gaps, while those starting their own practices watch overhead costs accumulate without corresponding revenue streams. The pressure to begin treating patients becomes intense, especially when office leases, staff salaries, and equipment financing don’t pause for credentialing delays.
Self-Pay Patients: The Immediate Option
The most straightforward way for providers to begin seeing patients immediately is through self-pay arrangements. Since no insurance reimbursement is involved, credentialing status becomes irrelevant from a payer perspective. Providers can establish their practices, begin building patient relationships, and generate immediate revenue.
However, this approach requires careful consideration of several factors. First, providers must ensure they hold all necessary state licenses and registrations before treating any patients. Second, they need adequate malpractice insurance coverage that doesn’t exclude self-pay patients. Third, they should establish clear payment policies and collection procedures upfront.
Many providers find that starting with self-pay patients helps them refine their clinical workflows, train staff, and work out operational kinks before dealing with the additional administrative burden of insurance claims processing.
Locum Tenens and Temporary Arrangements
Another viable option involves working as a locum tenens provider or accepting temporary positions with healthcare organizations that already have established credentialing relationships. These arrangements allow providers to practice immediately under the umbrella of the hiring organization’s credentials.
Locum tenens work offers several advantages during the credentialing waiting period. Providers can maintain their clinical skills, earn income, and build professional networks within their new geographic area. Many locum tenens companies also offer assistance with the permanent credentialing process as an added benefit.
However, providers should carefully review contracts to ensure these temporary arrangements don’t conflict with their pending credentialing applications or create non-compete issues that might affect their long-term practice plans.
Emergency and Urgent Care Scenarios
Healthcare facilities often face staffing shortages that require immediate solutions. In emergency situations, providers may be able to work under emergency credentialing provisions or temporary privileges while their full credentialing applications are processed.
Most hospitals maintain policies for emergency credentialing that allow qualified providers to begin working quickly when patient care needs are urgent. These arrangements typically require thorough verification of licenses, malpractice insurance, and primary source verification of key credentials, but they can be completed much faster than full credentialing reviews.
Emergency credentialing usually comes with specific limitations on scope of practice, supervision requirements, and time restrictions. Providers working under these arrangements should clearly document their authorization and ensure they operate strictly within approved parameters.
The Risks and Legal Considerations
While opportunities exist to practice during the credentialing period, providers must carefully weigh associated risks. The most significant risk involves potential liability issues if complications arise with patients treated before full credentialing is complete.
Malpractice insurance carriers may scrutinize claims more closely if they involve care provided outside of standard credentialing arrangements. Providers should explicitly discuss their situation with their malpractice insurance carriers to ensure coverage remains intact.
State medical boards also maintain strict requirements about practice arrangements and supervision. Providers must ensure their practice activities comply with all state regulations, regardless of their credentialing status with insurance companies.
Administrative and Documentation Requirements
Providers who choose to see patients before credentialing completion must maintain meticulous documentation of their arrangements. This includes clearly documenting payment arrangements with patients, maintaining proper medical records, and ensuring all regulatory requirements are met.
For self-pay patients, providers should establish clear written policies about payment expectations, refund procedures if insurance coverage is later obtained, and patient rights. Transparency helps prevent misunderstandings and potential disputes.
When working under temporary or emergency arrangements, providers must carefully document the authorization they received, any scope limitations, and supervision requirements. This documentation protects both the provider and the healthcare organization if questions arise later.
Strategic Considerations for Different Practice Types
The decision to see patients during the credentialing period varies significantly depending on practice type and specialty.
Here’s how different scenarios might play out:
- Solo practitioners and small group practices often have the most flexibility to see self-pay patients immediately. They can establish their own payment policies and don’t need to coordinate with larger organizational structures. However, they also bear full responsibility for ensuring compliance with all regulations.
- Specialists with limited emergency options may find fewer opportunities for temporary work arrangements. However, they might consider offering consultations, second opinions, or educational services that don’t require full credentialing but still provide value to patients and generate revenue.
- Primary care providers often have the most options, including urgent care work, locum tenens opportunities, and direct primary care arrangements that don’t rely on traditional insurance reimbursement models.
Financial Planning During the Gap Period
Providers should develop realistic financial projections that account for credentialing delays. This includes budgeting for extended periods without insurance reimbursement and planning for the cash flow challenges that inevitably arise.
Many providers underestimate the financial impact of credentialing delays. Beyond lost revenue, there are often additional costs associated with maintaining temporary arrangements, such as higher malpractice insurance premiums for locum tenens work or additional administrative costs for managing self-pay patients.
Smart financial planning also includes setting aside funds for potential credentialing-related expenses, such as additional document requests, site visits, or expedited processing fees that some insurers offer.
Building Patient Relationships During the Waiting Period
One often-overlooked benefit of seeing patients during the credentialing period is the opportunity to build strong patient relationships from the very beginning. Patients who receive excellent care during this initial period often become loyal, long-term patients who are willing to work with administrative challenges.
Providers can use this time to establish their reputation in the community, receive patient referrals, and demonstrate their clinical capabilities. These relationships and referral patterns often prove more valuable than the immediate financial benefits.
However, providers must be transparent with patients about their credentialing status and any potential implications for future care arrangements. Honest communication helps build trust and prevents problems if patients need to transition to different providers or payment arrangements.
Technology and Infrastructure Considerations
Providers seeing patients during the credentialing period need to ensure their technology infrastructure can handle both current needs and future growth. This includes electronic health record systems, billing software, and patient communication platforms.
Many providers make the mistake of implementing temporary solutions that create problems when they transition to full insurance-based practice. Investing in scalable systems from the beginning, even if it means higher upfront costs, often pays dividends in operational efficiency and reduced transition headaches.
Working with Credentialing Specialists
Given the stakes involved, many providers benefit from working with credentialing specialists who can expedite the process and help avoid common pitfalls. Companies like Medwave, which specialize in billing, credentialing, and payer contracting, can provide valuable expertise during this critical period.
Professional credentialing services often have established relationships with insurance companies, know how to navigate common obstacles, and can help providers avoid mistakes that might delay approval even further. While these services represent an additional expense, they often pay for themselves through faster credentialing completion and reduced administrative burden on provider staff.
Summary: Providers can Practice Even with Pending Credentialing Applications
Providers can indeed see patients while their credentialing applications are pending, but doing so requires careful planning, thorough risk assessment, and strict attention to regulatory requirements. Whether through self-pay arrangements, locum tenens work, or emergency credentialing provisions, opportunities exist to maintain clinical practice and generate revenue during the waiting period.
The key to making this work lies in transparent communication with patients, meticulous documentation of all arrangements, and ensuring full compliance with state licensing requirements and malpractice insurance provisions. Providers who take a strategic approach to this transition period often find themselves better positioned for long-term practice growth, having used the time to refine their operations, build patient relationships, and establish their reputation in the community.
For providers facing credentialing delays, remember that this period, while challenging, is temporary. Consider partnering with experienced professionals like those here at Medwave, who specialize in billing, credentialing, and payer contracting, to help streamline the process and position your practice for long-term growth.