Hospitals can be daunting if you work in the payor credentialing department. With hundreds of physicians and mid-level practitioners who need to be credentialed, how are you supposed to keep track of it all? Just when you think you have everything under control, providers leave the hospital or an influx of providers join as new staff. It changes day in and day out and can be mind boggling to the most experienced credentialer.
Below are key reasons why hospitals and facilities like urgent care and outpatient surgery centers should consider outsourcing credentialing:
- Cost: Simply stated, the cost of in-house credentialing is overwhelming. Employing people to manage this process means you must pay payroll tax, healthcare and training costs. You must also offer paid time off, FMLA coverage and a host of other things. When outsourcing to a credentialing firm these costs are eliminated. Missed days from work also become a thing of the past. When someone is out sick, or on vacation, and you use a credentialing company, the credentialing provider often supplies a replacement credentialer to take over while your assigned coordinator is out.
- Organization: Some of the most advanced hospitals in the country still do not own credentialing software. In fact, most organizations do not own credentialing software. With hundreds, and sometimes thousands, of providers to keep track of, you are likely to miss something if you do not have credentialing software specifically made to track license expiration dates, re-credentialing dates, project due dates, etcetera. Outsourcing to a credentialing company, especially one that has a proprietary credentialing technology, allows you to harness efficiencies without having to spend the money to own a software and maintain a database.
- Reporting: Many hospitals use Excel spreadsheets to track their credentialing work, making progress reporting challenging, confusing and subject to human error. A credentialing provider with a cloud-based credentialing system can give you access to customized reporting that will allow you to audit work, manage the credentialing workflow, track timelines, and identify bottlenecks in the credentialing process. Outsourcing to a proven credentialing company, with an established credentialing workflow and technology in place, can give you piece of mind – that the provider has the systems in place to deliver any information you need in a timely and concise manner.
- Oversight: When you are the client, it is much easier to put timelines into place and requirements for the work you want completed. A company that you have hired is always eager to please and contractually must perform the work. However, if you have your own in-house employees doing credentialing you may have to deal with employees who may be unwilling or unqualified to complete the work. In addition, since the oversight is within your own organization, it may be a complicated or lengthy process to replace someone. Often, organizations require the employee to be counseled over and over before finally allowing you to remove the person from the position. At this point, you’ve lost precious credentialing time that may affect your ability to send claims and, therefore, may impact your organization’s bottom line.
- Time: Generally speaking, when you outsource credentialing to a credentialing provider, a team will be leveraged to complete your credentialing work. These teams are usually much larger than anything you may have in-house. They perform tasks in groups rather than having one single person do each application. Through this team-based approach, credentialing provider companies are able to expedite, for instance, getting enrollment applications to payors. This type of structure is typically much more desirable if you have large projects or volume needs. Be sure to ask any company you are considering how they leverage their teams and assign work.
Consider reaching out to an experienced credentialing provider for assistance. You could outsource 100% of the work to the provider or have them assist you on a project or overflow work. Regardless of the need, a seasoned credentialing team can help you shorten the timeframe to get applications out, have a technology that could be leveraged, and reduce your costs.
Cynthia Young, the former CEO of STAT, which is a national billing, credentialing and practice management consultant. STAT is a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation, and other credentialing related services.