This article has been borrowed from our parent company’s credentialing company Physician Practice Specialists. It is a useful reminder of just how critical credentialing and contracting is to an organization. In this article we’ll take a minute and look at the importance of credentialing and how it could cost you thousands and quite literally put you out of business. Credentialing/Insurance Enrollment refers to, the time-consuming, delay-filled, frustration-generating necessity, and is often the last thing on a physician’s mind when running a practice. Unfortunately, it is often overlooked by your staff and could literally be a death sentence to your practice.
The Ripple Effect of One Revalidation Failure: A single rejected, or missed, recredentialing or revalidation application could result in thousands of unpaid claims. How many patients does one healthcare provider see each day? In a week? During the month? What is their average billing for each of these patient interactions? Now imagine having every one of these claims rejected because of a revalidation error or recredentialing oversight. Each related claim will be placed on hold until the revalidation is completed. This delays reimbursement. Then each claim must be resubmitted. More reimbursement delays. The more time that passes after seeing the patient, the greater the likelihood some event will cause the claim to be denied. More delays and some denials, all because credentialing was at the bottom of the stack instead of on top of it.
An Expensive Scribe: A new hire who can’t see patients because of credentialing is about as valuable as a scribe. For a new physician, you should expect the credentialing & contracting to take at least 90 days, and a month or so longer for a graduating resident or fellow. That’s four to five months of payroll costs for an expensive employee without the benefit of incoming revenue to offset it. Each delay in gathering information, submitting it, and needing to correct errors, serves to push the timetable back even more. Though I suppose the doctor in question could see cash-only patients but how many of those are there?
Rejected Claims Spike: Denials skyrocket because of participation issues. When a physician’s status is in question because of credentialing or recredentialing, the response to claims can vary. The most likely result is a huge jump in denied claims. Minimize this by handling all credentialing or recredentialing in a timely, accurate, and proficient manner.
With so much at stake regarding credentialing and recredentialing, each error, delay, or misstep has profound financial ramifications that damages the healthcare organization’s bottom line and threatens its very viability. Don’t risk this critical step by turning it over to well-meaning staff who try their best but often encounter unexpected problems or are simply stretched in too many directions.
Instead turn it over to experts who specialize in credentialing, doing it every day throughout the year for thousands of healthcare professionals around the country. You’ll be doing yourself and your organization a huge favor. Urology Practice Specialists is a division of Physician Practice Specialists and handles all of our client’s credentialing and insurance negotiation needs.