Streamline Your Practice with Medical Credentialing Services

The healthcare industry is always in constant checks to ensure every health provider is competent in offering medical services. This is the purpose of the credentialing process. Medical providers seek Medical Credentialing Services to enable them to be reimbursed, to enable them to comply with standard regulations, and to make sure that practitioners work effectively in the medical system. Credentialing captures the process of verifying a healthcare practitioners' credentials, education, specialties, and licenses from respective boards and insurers.

Medical-Credentialing-Services

For healthcare practitioners, an efficient credentialing process is important for the continuous running of the business. No matter when you are bringing on new employees, changing your business scope, or ensuring that providers comply with modern requirements, credentialing services ease the process and minimize the workload on the administration.

This blog will highlight why Medical Credentialing Services are relevant for healthcare providers, the problems it poses, and how outsourcing credentialing activities to specialized services can result in improved operational efficacy, regulation cost savings, and revenue growth.

What Are Medical Credentialing Services?

Medical credentialing is defined as the process of verification by healthcare institutions, insurance providers, or government payers to determine if a given provider is qualified and meets set standards and requirements. This includes education level, training, licensing, type of certification, and other related employment.

Some common services that you can expect may include:

Education Verification: 

Educational degrees, certifications and other training/fellowship accomplishments achieved by the provider.

License Verification: 

Valid and active licenses for the state or states where the provider practices.

Board Certification: 

Determine whether the provider is certified by the particular specialty board.

Work History and Experience: 

Employment record including clinical practice experience of the provider.

Malpractice Insurance Coverage: 

Proof of malpractice insurance coverage which meets industry minimum coverage requirements.

Criminal Background Check: 

No criminal background that will adversely affect the provider’s ability to practice.

Credentials also need to be validated because things do change for healthcare service providers. Regulatory compliance, renewals of licenses, certifications and even credentials require special attention. For a healthcare organization, this could be a never ending activity that is cumbersome and time sensitive.

The Relevance of Medical Credentialing Services to Health Service Providers 

1. Making Sure of Compliance and Regulatory Obligations 

Medicine as a field is highly regulated, and as such there are various standards, laws, regulations on federal, state and payer jurisdiction that healthcare providers are expected to comply with. For instance, not properly credentialing your healthcare providers may result in compliance issues, reimbursement issues, and even getting sued. Medical Credentialing Services professionals have a systematic approach that sets the framework, documentation, submits reports, and ensures healthcare providers follow the laws and regulations relevant to them.

This helps avoid violation fines and helps your practice billing circle maintain good relationships with insurers and compliance authorities.

2. Simplifying the Credentialing Process 

Without sufficient resources or the relevant knowledge, credentialing can be challenging for a practice’s administrative staff because it is paper intensive and time consuming as much as it is process intensive. Medical credentialing services alleviate the administrative burden by implementing the necessary documentation, follow up with relevant authorities, and obtain updates for any relevant missing or altered data.

In turn, this can help free up resources for other critical areas of work such as patient care and effective management of the revenue cycle.3. Accelerated Candidate Onboarding

When a new provider joins your practice, it is important to make sure that they are credentialed and enrolled in the appropriate insurance networks so that they can start attending to patients and earning money as soon as possible. Medical Credentialing Services help complete the credentialing process faster so that new providers become active in your practice quicker.

This is particularly important for high volume practices or practices that cannot afford to be short-staffed for long periods of time.

3. Elimination of Payment Delay and Denial Issues

Credentialing is a vital part of how your practice will get paid for services rendered in a timely manner. When credentialing is poorly done, payments can get lost, causing disruptions in cash flow and possibly harming the financial well being of your practice. Medical credentialing services make sure that all credentialing procedures are compliant, and that practitioners are appropriately enrolled in the insurance networks, which greatly reduces the chances of reimbursement problems.

4. Decreasing Risks and Liabilities

One, improper credentialing may lead to insufficiently qualified or even unlicensed healthcare providers claiming malpractice or negligence, but proper credentialing makes sure that its practitioners are capable of working in the field responsibly. Therefore, by hiring credentialing services, you can maximize your healthcare practice by hiring properly credentialed providers while safeguarding your practice from needless lawsuits and other legal actions.

Common Issues Faced in Medical Credentialing

As much as these credentialing systems can benefit the health practitioners, they too come with their own challenges. Here are some common problems that come alongside with the benefits of credentialing medical practices:

1. Lengthy Documentation Procedures

In order to obtain former credentials, one needs to acquire a background check and verification documentation pertaining to their area of practice. This formality is often the most strenuous and taxing component of the process since it requires verification as well as information gathering from a vast range of sources. Such an enormous task becomes exacerbated when one tries to juggle several providers simultaneously.

The total amount of documentation alone can cause delays or mistakes if not managed carefully.

2. Changes and Updates Must Observed Changes

Credentialing of health professionals is not a single activity. Providers must always update and renew their license, certificates, or even their insurance policies. Ensuring that all of these individual credentials are kept up to date is a herculean task for your administrative team. If one fails to meet the renewal deadline, payment cycles may be stalled or worse, suspension from the insurance network will take place.

3. Unique Needs of Each Health Organization

Different insurance companies have their own policies and requirements concerning the issue of credentialing, which are sometimes very different from one another. Such requirements include certain forms to be filled, additional documentation, submitting them within set timelines, etc. It is very cumbersome and complicated to try and understand these specific requirements and to organize them.

4. Delays in The Process and Backlogs

Since credentialing is an activity that entails many processes and involves many people, it is very reasonable for there to be delays in the process. This may cause a backlog of some sort, where new providers are not in a position to start treating patients and make revenue for weeks or months.

Outsourcing Medical Credentialing Services are a Solution to Problem. 

Practices need Medical Credentialing Services, and it is oftentimes hard to find an in house solution for it. Here’s how outsourcing can solve your problems: 

1. Payment and Services.

Credentialing companies are created to handle the credentialing service – they are well versed with all of the legal requirements, payer policies, and best practices. With gained experience, they are able to complete the task accurately and fast. Because of their expertise, there is little to no issues that arise which lead to payment delays or legal issues. 

2. Efficiency

Credentialing services help save your practice time. Allowing the credentialing service provider to manage all of the documentation, follow ups, and verification while your practice stays incognito allows your practice to focus on patient care and improving overall office efficiency.

3. Speedy Provider Recruitment

The credentialing companies have the skills and experience to complete the onboarding process in less time. Their systems are such that new providers are credentialed and placed into the insurance networks as quickly as possible. This allows the new providers to begin to see patients and start earning revenue, which is essential to cash flow.

4. Compliance and Risk Reduction

Outsourced credentialing will ensure that your practice remains compliant to healthcare regulations and payer specific requirements. In addition, credentialing services have ongoing supervision and modifications which reduce the error risk which comes with credentialing such as malpractice or non-compliance with insurance policies. This shields your practice from spending excessive money on fines, penalties and legal expenses.

What makes Mava Care Medical Billing Company suitable for your credentialing?

For healthcare providers looking to make their credentialing process easier, Mava Care Medical Billing Company provides one-stop services that clients can trust. Mava Care Medical Billing Company has years of experience in medical billing and credentialing, so a proper and thorough compliance with all regulations is availed, and the providers get credentialed without causing payment delays and operational issues. 

By working with Mava Care Medical Billing Company, you are provided with:

• Professional services in credentialing where every detail of the process is managed.

• When a provider is onboarded on time, there are far fewer misses with reimbursement payments and services that need to be rendered. 

• Lessening the administrative workload means your employees can devote more of their time providing support for patients.

• Compliance management is needed to ensure that all the providers follow the policies and regulations to avoid potential lawsuits.

• Having your credentialing done by Mava Care Medical Billing Company means you can be assured your practice is operating in an efficient, compliant, and financially sustainable manner.

Conclusion:

Medical credentialing is a necessary process across the healthcare field because it helps determine if providers have what is needed to deliver health services properly. With the help of Medical Credentialing Services, most healthcare practices will be able to lessen their administrative tasks, compliance challenges, and get paid on time.

The need to verify a health professional’s qualifications and experience is essential to patient safety and quality assurance. Outsourcing credentialing services to a specialist provider such as Mava Care Medical Billing Company helps save time and eliminate mistakes, making the process more effective. You can depend on improved readiness once you have expert assistance to make sure your practice is compliant and efficient.

To compete effectively in the healthcare system today, establishing a trustworthy credentialing service is critical to success.