What Is Credentialing In Medical Billing
Credentialing helps medical facilities ensure that their practitioners meet all the standards necessary for providing optimum patient care. It is a process of validating a healthcare provider’s education, training, and expertise. It helps certify that they are qualified for their practice. Not only does this lower the risk of malpractice, but it also helps a medical facility avoid legal and regulatory pitfalls.
But how important is credentialing in medical billing?
The simple answer is, ‘significantly’. It is much like a pillar keeping the integrity of the healthcare ecosystem intact. It is the very process that maintains patients’ trust in their medical providers.
What is Credentialing in Medical Billing?
Credentialing is a process of verifying that a healthcare provider has all the necessary qualifications and skills to perform their medical practice. It is a standard protocol to confirm that they have had optimum training before being allowed to provide patient care. And it requires extensive paperwork, which can take three to five months. During this time, they cannot legally practice medicine.
Medical credentialing involves examining the following aspects to validate a practitioner’s right to practice:
- Training
- Education
- Licenses
- Residency
- Qualifications
- Certificates
- Work history
What Are The Types Of Medical Credentialing?
There are two types of credentialing.
Initial credentialing
This process involves verifying the qualifications, training, and residency of the newly hired practitioners. It is the preliminary check to confirm that a healthcare provider is ready to start their practice.
Re-credentialing
This process refers to a periodic check of working healthcare providers’ qualifications. It helps ensure that they are getting timely certification and training to keep up with their practice requirements.
The Process Of Credentialing In Medical Billing
The credentialing process involves the following steps.
Information Collection
This step involves a medical practice collecting a practitioner’s credentials including educational certifications, licensure, and previous work details.
Verification
The medical facility verifies all the credentials by contacting authority sources, such as the practitioner’s medical school or the residency instructor. They check all the references to validate the practitioner’s license.
Evaluation
Once the information has been validated, the healthcare facility examines the practitioner’s skills and expertise. This is to ensure that they can meet the job requirements. The factors evaluated in this regard include the doctor’s clinical approach, patient outcomes, and commitment to clinical protocols.
Recommendation
After completing the evaluation, the medical facility states its recommendation regarding whether to allow the healthcare provider to practice medicine. They notify the physician and other concerned stakeholders about their decision.
What Is The Importance Of Credentialing In Medical Billing?
Below are the reasons why medical credentialing remains an integral part of the US healthcare system.
Patient’s confidence
For any medical facility, the primary payer is always the patient. Therefore, patients’ trust remains an invaluable asset. This makes sense. Patients who trust their physicians are more likely to stay loyal. And the first step towards building that trust is to get your doctors properly credentialed. Moreover, credentialing your physicians makes you a reputable organization that doesn’t compromise on authenticity. Not only does this make you a preferable choice for your patients, but other healthcare facilities also consider you an authority in the industry.
Quicker Reimbursements
As mentioned above, a proper credentialing framework improves your reputation in the industry. This reputation doesn’t remain restricted just to your patients and other healthcare facilities. You also earn a respectable position among insurance companies and third-party payers. This is because payers demand practitioners’ credentials. Providing them with this crucial documentation paves the way for quicker payouts.
Proper credentialing also makes it easy for you to contact top payers in the industry. And once that happens, you can rest assured of an enhanced cash flow.
Reduced Medical Errors
Your healthcare organization is less likely to make mistakes if you have top medical experts on board. Remember the patients’ trust part mentioned above? That comes into play here. Your patients’ confidence gives you a boost as well as the obligation to stay error-free.
Conclusion
Medical credentialing is a crucial aspect of healthcare service provision. It helps ensure that your practice retains the best resources for your medical practice. However, this process is as complicated as it is vital. This is because it involves intricate steps and thorough evaluations that require expert credentialing services.
At AltuMED, we offer comprehensive medical billing and credentialing services to help you manage your practice more effectively. Our credentialing experts look into every detail and parameter to assist you in optimum talent acquisition.
Subscribe to Our Newsletter!
Subscribe to Our Newsletter!
Enter Your Email Address. We Promise We Won't Spam You