Many physicians start their careers with big dreams of improving patient care and making a difference in their communities. But, after years of grueling education and training, many are surprised to find that their first task after getting hired or opening their practice isn’t patient care—it’s credentialing.
Credentialing can be incredibly tedious, especially if the newly hired or independent practitioner has to navigate it alone. Worse, it can take months to complete, delaying the physician’s ability to see patients and get paid. This is just one example of how vital physician credentialing services costs can be in the healthcare credentialing workflow.
In this guide, we’ll explore the average cost of these services, factors that affect pricing, and how outsourcing to a qualified vendor can help practices save time and money. Outsourcing can help ease the burden of credentialing so that healthcare organizations can focus on what matters: patient care.
Importance of Physician Credentialing
Instills Confidence in Patients
The state of mind of your patients plays a significant role in the healing process. Patients who trust their physicians can feel better about following doctor’s orders, from changing diet and exercise to trying a new medication or undergoing a procedure. Of course, patients confident in their doctors will also be more likely to stay with the practice and won’t be looking around for a more competent physician.
Having fully medically credentialed nurses and doctors makes your organization more appealing to other employees, from new physicians, PAs, LVNs, RNs, nurse practitioners, and support staff. They’ll want the prestige that comes from knowing colleagues are all well-trained and up to speed on the latest in the medical industry. You encourage future excellence by highlighting the current outstanding abilities of your team.
Establishes Your Professionalism
It’s best to demonstrate professionalism in a healthcare setting with irrefutable documentation. Taking the time to complete the paperwork required to show your credentials is a small price to pay for assuring patients of your bona fides. Healthcare Innovation noted, “Through a standardized process involving data collection, primary source verification and committee review by health plans, hospitals and other healthcare agencies, patients are assured of their healthcare professional’s merit and experience.”
In the past, medical professionals may have balked at credentialing because of all the paperwork they’d have to wade through. However, modern methods allow much of this information to be handled online. Check that your team can use electronic credentialing for any entities that want to check your standing, such as before you start a contract with another organization or before any hospital can allow you to become an affiliate.
Details to provide include where you went to medical school, your internship or residency location, your board certifications, and your curriculum vitae. Of course, you’ll also note information about your malpractice insurance and your current, valid medical license.
Required for Compensation
You’ll need to be medically credentialed, as this is required for reimbursement from insurance companies. Getting the documentation finished promptly ensures that a new nurse or doctor you’ve hired can begin providing services on hiring day. To that end, many organizations will require applicants to have their documentation set up well beforehand.
It’s not a task to put off, and the time frame can vary from state to state because of differences in regulations and credentialing laws. Private health insurance companies, such as Medicare and Medicaid, will want proof of medical credentialing before allowing your staff to engage with patients.
Cuts Down on Medical Errors
When healthcare professionals obtain proper medical credentials, it helps to support the safety and security of the entire industry. Medical errors are implicated in 98,000 deaths in America (per Healthcare Innovation’s report), making the importance of medical credentialing clearer. Patients have a right to trust that their healthcare providers know what they’re doing and are working in a safe and approved fashion.
Ensures You Have Adequate Staff Levels
If you’ve been having problems maintaining the requisite staff levels to serve your local community, medical credentialing is essential to fill out your team. New medical staff candidates who aren’t coming from a job placement company (that would help them with credentialing) should get started with medical credentialing as early as possible. It could take as many as four months to complete.
To help pave the way, create resources such as a credentialing packet to give to all new hires. It will support them through the application process. Your human resources department would be well advised to track all candidates’ medical credentialing status and identify any obstacles that could delay onboarding new hires.
Who Needs Physician Credentialing
Healthcare professionals who deliver patient care must have the proper credentials to practice safely. Medical credentialing is required for all healthcare providers, regardless of their specialty or level of training. At Physician Practice Specialists, we help physicians, nurse practitioners, physician assistants, therapists, labs, ASCs, and behavioral health providers through the process.
Credentialing is mandatory for healthcare providers who want to work with insurance companies, hospitals, and healthcare organizations. Private insurance companies are not the only insurance companies that require credentialing. Healthcare providers wishing to participate in Medicare, Medicaid, and other government-funded healthcare programs must also undergo credentialing.
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Physician Credentialing Services Cost
The Price of Keeping Your Staff Credentialed: In-House Costs
Physician credentialing is a critical process that verifies a physician’s qualifications, ensures compliance with industry standards, and enables participation in insurance networks. The costs associated with credentialing can vary based on several factors, including the method chosen (in-house vs. outsourcing), the number of providers, and specific service requirements.
In-House Credentialing Costs
Managing credentialing internally involves direct expenses related to personnel and resources:
Personnel Costs
Credentialing requires dedicated staff to handle application processing, verification, and enrollment. Employing credentialing specialists can be costly, with salaries, benefits, and training adding up quickly.
Additional Staffing Expenses
The time and resources spent by office staff on follow-up, compliance checks, and document management add up.
Software and Tools
Credentialing requires specialized software for tracking provider credentials, renewal dates, and compliance requirements.
Verification Fees
Primary source verification is critical, often requiring payments to state boards and other institutions.
Potential for Errors
Mistakes and incomplete applications often result in additional processing fees and re-submission costs, increasing time and financial expenditures.
Outsourced Physician Credentialing: The Costs of Streamlining Operations
Outsourcing credentialing to specialized firms can streamline the process and potentially reduce costs:
Setup Fees
Depending on the number of providers, some companies charge an initial setup fee for new clients, ranging from a few hundred to several thousand dollars.
Individual Physician Credentialing
Costs typically range from $100 to $200 per provider per month, with re-credentialing at a similar rate, generally on a two-year cycle.
CAQH Database Management
The initial setup costs $200–$500, with essential management averaging $50–$100 monthly.
Insurance Panel Applications
Depending on complexity, each application may cost around $100, sometimes higher.
Factors Impacting Credentialing Costs: What You Need to Know
Several variables can affect the overall cost of credentialing:
Current Credentialing Status
The complexity of services required can vary based on whether the provider is new or undergoing re-credentialing.
Number of Providers
Larger practices with more providers may incur higher total costs, though some firms offer group pricing that can reduce the per-provider expense.
Practice Growth Rate
Rapidly expanding practices may require more frequent credentialing updates, impacting costs.
Insurance Contract Changes
Alterations in contracts or providers can necessitate additional credentialing efforts, influencing expenses.
Geographical Location
Regional factors, such as local market conditions and regulatory requirements, can cause credentialing costs to vary.
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6 Steps for Successful Physician Credentialing
Step 1: Use Azulity to Streamline the Credentialing Process
Azulity specializes in healthcare master data management and provider credentialing services. The company brings proven expertise in implementing healthcare data solutions and credentialing across the United States. Their comprehensive platform ensures consistent patient, provider, location, and claims data synchronization across all systems and departments.
Key features include healthcare master data management, provider master data management, reference data management, credentialing, and provider enrollment. Azulity serves healthcare technology leaders from CIOs and CDOs to VPs of data platforms and credentialing. Their services help eliminate the costly problems of fragmented data systems.
Step 2: Complete the Application
Credentialing applications can be lengthy and tedious. Each facility has its application, so doctors must usually complete one for each facility they’ll be working at. These can range from 10 to 100 pages in extreme cases. Be prepared to invest some time to get this right.
Step 3: Submit Supporting Documents
Supporting documents may include your medical licenses, Drug Enforcement Administration (DEA) ID number, malpractice insurance carrier and case information, board certification, education and work history, and health documentation. Many facilities also require activity or procedure logs.
Step 4: Prepare for Verifications
Once you apply for supporting documents, the medical staff services office begins verifying malpractice carriers, work history, education, and peer references by contacting the organizations or individuals directly. This process can take time, so it is best to be prepared for any questions and respond quickly to requests for additional information.
Step 5: Wait for Approval
Generally, department heads and hospital boards meet to discuss the application and supporting documents and approve the physician’s employment. Some facilities require only the approval of the medical staff services office. This process can take up to a month or longer, depending on the number of meetings.
Step 6: Re-Credentialing (If Necessary)
Some facilities only grant privileges for the time the doctor will be working (for example, three months on a locum tenens assignment). Other facilities grant credentialing for a full two years for permanent and locum physicians. Either way, you may be required to reapply and provide documentation again to maintain your credentialing and hospital privileges.
Book a Call to Learn More About Our Provider Credentialing Services
Physician credentialing services cost an average of $36,000. This number represents the total cost of all the resources and time associated with credentialing a single physician, from start to finish. Research estimates that the process takes 120 days and involves several stakeholders, both internal and external, who contribute to the overall time and costs.
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