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From medicines to machines, there’s a long list of costs that make the healthcare industry expensive to manage. One expense that some individuals are incredibly familiar with, and maybe wish they weren’t, is credentialing. Provider credentialing is crucial for the success of healthcare companies, but it can push an already strained budget to the brink. Credentialing can put money in your pocket, but the old adage also strikes true: it takes money to make money. So how much does credentialing truly cost?

The average cost of credentialing is difficult to determine. There are many factors at play that cause the final costs to vary significantly for each healthcare institution. Let’s take a look at the factors that can influence the cost of medical credentialing the most.

What Is Medical Credentialing?

Before you start asking how much credentialing costs, there’s an important question to answer first: What is medical credentialing? In the healthcare industry, credentialing is the process of verifying that a potential candidate has the necessary qualifications to properly carry out their given role. It’s like a background check on steroids. 

During the credentialing procedure, a candidate’s documentation is sent back to the institution that first issued them, such as a university to confirm their legitimacy. Once the validity of a physician has been checked, hospitals will know that the candidate has the right experience to perform in their position. 

This process is incredibly important for patients and employees that will be working with the provider. The Office of Inspector General for the Department of Health and Human Services is basically like the FBI of the HHS and they have a list of thousands of individuals and entities excluded from federally funded health care programs for a variety of reasons, including a conviction for Medicare or Medicaid fraud. Should a hospital hire an inexperienced or excluded individual, they place the wellbeing of their patients in jeopardy, and put their institution at risk for being non-compliant.

The Costs of Not Credentialing

If you’re familiar with the nuances of provider credentialing, there’s probably been a time in your life where you’ve found yourself surrounded by files, multiple excel spreadsheets open, rubbing your eyes, and asking yourself, what if I didn’t do this?

After all, there is a bit of a loophole under the Incident-to rule that allows a non credentialed physician to bill under a credentialed physician for services. But even under this rule there are different standards for different payers and in different states regarding how to handle incident-to billing and an error can lead to fines and even more work. 

Additionally, the price of not thoroughly credentialing can manifest as inexperienced physician errors, which will cost the hospital money in damages and a loss of reputation.

To credential, or not to credential, that is the question. And proper credentialing is the resounding answer.

Physician Credentialing Services Costs Vary

Now that we understand how credentialing is valuable, let’s work on figuring out what the value of credentialing is. There are many factors that can influence the price of credentialing, including how many doctors you wish to add to your team and how quickly you intend on growing your facility.

Another key difference that can reduce costs is the method you choose to perform the process. Hospitals have several options available in regards to how credentialing is carried out that can ultimately influence the final cost. Let’s explore those options.

In-House Credentialing

Credentialing can be performed with an in-house team of professionals. The average Medical Staff Credentialing Specialist salary in the United States is $42,374, according to Salary.com

Depending on how many providers, locations, and payers you have, you will want a few specialists and support staff. You will also need to factor in office space, office equipment, benefits, and training. Not to mention retention and replacement as most employees only stay in a position for 3-4 years. When training, errors are more likely to occur which can add to payer enrollment expenses or lengthening the time credentialing takes.

Given how time-consuming and demanding the credentialing process is for your team, you may find it is at the expense of precious time and resources that would be better spent elsewhere in a busy healthcare environment.

Outsourcing Credentialing

Many healthcare organizations outsource their credentialing management, as it costs less money and time than to perform it all in-house. For example, hospitals can outsource credentialing services to medical billing companies. The outsourced company will typically assign each credentialing task to a respective medical expert, meaning healthcare institutions won’t have to spend time or money searching for professionals themselves.

However, the services of a medical billing company are limited and you may not have access to records or details you need to develop reports for key stakeholders. You may need to keep track of all of your files as they will not offer storage and you may have to follow up on deadlines for recredentialing. 

Credentialing Software

The most efficient and streamlined method of achieving effective credentialing is finding a credentialing software service. Using a cloud-based system allows facilities to store unlimited candidate data online, making it much easier to access and track. With an online program, healthcare organizations can save time because it’s faster to locate candidate documents and send them out for approval via browsers instead of paper copies.

Credentialing software can also include other tools your organization needs such as a way to manage privileging, automated reminders, facility credentialing, and more.  Apart from drastically improving the efficiency of a facility’s workflow, credentialing software like MedTrainer can also offer a package deal for Training and Compliance tools. 

With MedTrainer, your healthcare organization can take advantage of 500+ training courses and onboarding paths, as well as Compliance Management which offers incident reporting and contract management tools.  

At MedTrainer, we strive to offer a wide array of services to help make operating a hospital easier and less stressful! Contact us today for more information on MedTrainer’s management programs and our physician credentialing services cost.