In the healthcare world, medical credentialing opens doors that would be previously closed to medical providers. With more patients than ever being insured, the ability to be reimbursed by insurance companies allows medical practices to deliver care to more patients than ever - and increase their overall revenue potential.
While it’s necessary in order to access new patient audiences, the medical credentialing process can be lengthy and time-consuming. To expedite the process, understanding how medical credentialing works can help your practice streamline all your credentialing needs.
What is Medical Credentialing?
Medical credentialing is the process used by insurance payers to evaluate and verify the qualifications of a doctor or other practitioner. The process involves verifying the physician’s education, training, residency, licenses, malpractice coverage, clinical judgment, and any certifications related to their specialties. The insurance payer uses data collection, source verification, and committee review, among other requirements to maintain that the practicing physician is maintaining the standard of quality in the medical community.
The physician credentialing process typically involves two parts: credentialing and privileging. While the credentialing process verifies the physician’s competence by assessing education, training, licensing, and work experience, privileging is the granting of approval for the physician or medical practice by the insurance payer to perform the specific procedures based on the review of the verifications.
What is the Purpose of Medical Credentialing?
The physician credentialing process serves several purposes. Credentialing provides quality assurance to the medical industry by ensuring that all physicians are operating to the standard quality of care and are providing the clinical services that they are qualified to do so. This protects both the safety of the patient, but also the medical community by ensuring that only physicians with the knowledge and skills to perform certain procedures are allowed to practice on insured patients.
Medical credentialing also allows medical practices to receive their proper reimbursements and on-time payments from their contracted third-party payers. Credentialed medical practices can expand their revenue streams by increasing the number of patients who have access to them. With easier payment methods and greater pools of patients, medical credentialing is integral for successful medical practices.
7 Reasons Why Medical Credentialing is Important for Your Medical Practice
Physician credentialing holds a plethora of advantages for medical practices looking to be credentialed and privileged by an insurance company. Just some of these reasons include the ability to:
1. Ensure Quality Assurance
As mentioned previously, the medical credentialing process provides quality assurance in the healthcare field. It’s a method of review for the medical industry and helps to ensure that the standards of quality in the medical community are consistently met for the sake of patients. In order to keep costs down, insurance companies are inclined to only privilege medical physicians and practices who have demonstrated the competence to perform their specialties.
2. Maintain Patient Safety
Credentialing helps to protect patient safety by ensuring practices and physicians have the experience and skills necessary to perform procedures on patients. The process helps reduce the risk of medical errors that may be caused by incompetent providers. With all this background knowledge, credentialing helps to restore the trust between patients and medical practices. Patients who know their physicians have the qualifications and merit to be their chosen providers allow them to place their full trust in their competence.
3. Prevent Losing Revenues
Proper credentialing can help prevent medical practices from losing thousands of dollars in lost revenue from delayed or denied reimbursements. Neglecting to receive proper credentialing or mistakes in the process can result in insurance payers failing to reimburse medical practices for their treatments. In a situation where a medical practice allows a physician to deliver services to prior to or during the credentialing process, the insurance payer may be able to backdate the reimbursement to cover the treatments.
4. Increase Your Patient Base
Physician credentialing allows medical practices access for patient bases previously inaccessible to them since it allows practices to accept paints covered by health insurance. The majority of Americans have health insurance plans; in 2019 alone, 92% of Americans had health insurance coverage. This allows medical practices to increase clientele and potentially boost revenue streams.
5. Improve Your Practice Reputation
More patients than ever before are researching healthcare practices and their physicians before committing to them. This may look like checking their background or patient reviews online. Undergoing medical credentialing is one of the best ways to boost your online reputation. When potential patients are researching your medical practice, seeing credentials translates that your practice is merited, reputable, and should be trusted.
6. Enhance the Hiring Process
When a physician is benign credentialing, they must go through a thorough examination process that examines their residential history, educational background, work experience, and any other merits. If your medical practice is hiring a medical practitioner who must be credentialed, then this process can verify if they are competent enough to perform the job description tasks.
7. Deliver a Competitive Edge
In the competitive world of healthcare, medical practices must find ways to stand apart from the crowd. Medical credentialing proves to possible new patients that your medical practice has physicians who are experienced in their specialty. Additionally, being credentialed can help you enlist well-qualified physicians to your practice who would be more inclined to join a credentialed practice with a larger patient base than one who isn’t. The medical credentialing process allows your medical practice to have an advantage over those who aren’t in your market and continue your growth.
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