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From medicines to equipment, 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 the cost to credential a physician.

Provider credentialing is crucial for the success of healthcare organizations, 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?

What Is Medical Credentialing?

Medical credentialing is the rigorous procedure of verifying that a physician possesses the necessary qualifications and experience to perform their job competently and safely. This process involves many steps, including:

  1. Primary source verification ensures that a physician’s educational and training credentials are authentic and up-to-date.
  2. Exclusion checks ensure the physician is not on government or industry exclusion lists for prior malpractice.
  3. Payer enrollments are necessary to ensure a physician is approved to provide services to patients covered by various health plans.
  4. Privileging is when a physician has permission to perform specific medical procedures or services.
  5. Recredentialing is the periodic renewal of credentials to ensure ongoing compliance with regulatory and quality standards.

By completing these steps, hospitals and healthcare institutions can have confidence that they’re working with qualified and competent physicians who meet the highest standards of patient care. However, it’s worth noting that this process can be time-consuming and expensive. It’s why many organizations turn to software and services like MedTrainer to help streamline and optimize the credentialing process.

The Costs of Not Credentialing

If you’ve ever found yourself buried in files and multiple Excel spreadsheets while working on physician credentialing, you might’ve wondered whether it’s worth all the effort. However, once you learn that failing to thoroughly credential physicians can have serious consequences that far outweigh the time and cost involved in the process, it’s easier to see its necessity.

  • Risk of fines and legal penalties. Under “incident to” rules, there are different standards for billing across payers and states, and even a small error can lead to costly fines and additional work.
  • Inexperienced physician errors. New doctor mistakes cost the facility both in terms of damages and reputation. Proper credentialing protects every party interacting with the physician.
  • Risk of hiring excluded physicians. The Office of Inspector General for the Department of Health and Human Services maintains a list of individuals and entities excluded from federally funded healthcare programs, including those convicted of Medicare or Medicaid fraud.

The question is not whether to credential, but rather how to do it effectively. It ensures that hospitals work with qualified and competent physicians who meet the highest standards of patient care, reducing the risk of legal penalties and reputation damage.

The Cost of Credentialing Delays

In the process of credentialing providers, time is of the essence. Every day without proper credentialing means losing revenue for the provider and the organization. Moreover, the longer it takes to complete the process, the higher the risk of losing high-caliber providers.

The manual credentialing process takes around 180 days. Here’s how it breaks down:

  • 30-60 days for location onboarding and provider document acquisition
  • 90-180 days for initial primary source verification and initial exclusion checks
  • ~4-8 hours uninterrupted per provider/payer to complete payer enrollment, facility privileging, provider profile management, CAQH profile management, payer calls, and payer market research

While manual credentialing may seem like a necessary evil, it’s far more time-consuming and prone to errors than automated systems. Using a credentialing service like MedTrainer can help organizations reduce their credentialing expenses by an average of 50%! More importantly, MedTrainer customers can credential providers three weeks faster, on average.

The Costs of Various Physician Credentialing Methods

Credentialing is a vital aspect for healthcare organizations, and the costs associated with it can vary depending on several factors, including:

  • Current credentialing status
  • Number of physicians
  • The growth rate of the practice
  • Changes in insurance contracts or providers
  • Other services provided by the credentialing provider

On average, the cost of physician credentialing is approximately $2,000-$3,000 per year. Here’s a breakdown of the costs associated with individual pieces of the credentialing process:

  • Individual physician credentialing costs between $100-$200 per physician. Most insurances and facilities require recredentialing every two years, which may vary.
  • The CAQH Proview database is an option for online provider data collection. The initial setup cost is $200-$500, and basic database management can cost around $50-$100 per month, depending on the level of involvement from the credentialing provider.
  • Insurance panel applications usually cost around $100-$200.

These costs add up fast; however, they’re nothing compared to the costs that can accompany the fines and fees following the mistakes of an uncredentialed physician.

In-House Credentialing

Medical credentialing is a necessary process you can do in-house using a team of professionals.

According to Salary.com, the average Medical Staff Credentialing Specialist salary in the United States in 2023 is $43,558. Depending on the number of providers, locations, and payers, you may need to hire multiple specialists and support staff. Remember to also factor in office space, equipment, benefits, training, retention, and replacement costs.

Or, if you decide to train your in-house team, this can lead to errors, adding to payer enrollment expenses or lengthening the time it takes to complete the credentialing process. Given the time-consuming and demanding nature of the credentialing process, it may come at the expense of other essential tasks in a busy healthcare environment.

Outside Credentialing Service

Outsourcing credentialing services means that the third-party service takes care of primary source verification, payer enrollments, facility privileging, and recredentialing, among other things. There are many benefits to outsourcing credentialing services, including:

  1. Time-saving: The credentialing process can be incredibly time-consuming. Outsourcing it to a third-party service frees up time and resources for healthcare organizations to focus on core business functions.
  2. Reduced errors: Third-party credentialing services have dedicated staff and technology that can help reduce the risk of errors and improve the accuracy of the credentialing process.
  3. Cost-effective: Outsourcing credentialing services can be cost-effective in both time and money. Third-party services can reduce the time and money spent on credentialing.
  4. Compliance: Outsourcing credentialing services can help ensure healthcare organizations comply with state and federal regulations.
  5. Access to expertise: Third-party credentialing services often have experts knowledgeable about the latest standards and best practices.

Credentialing Software

Cloud-based credentialing software allows healthcare facilities to store unlimited candidate data online, making it much easier to access and track.

Credentialing software can offer additional tools to help healthcare organizations manage their workflow and improve compliance. For example, MedTrainer has tools for managing privileging, automated reminders, and facility credentialing.

Credentialing Service vs. Software: What’s the Difference?

Full-Service

MedTrainer provides credentialing and compliance services as part of a full-service solution to the credentialing process. This service includes:

  • Managing the credentialing process
  • Primary source verification
  • Payer enrollments
  • Privileging
  • Recredentialing
  • Compliance management
  • Training and education

Cloud-Based Software Platform

MedTrainer offers a cloud-based platform that helps healthcare organizations streamline the credentialing process. That includes storing, managing, and tracking provider data, to make it easier for healthcare organizations to access and monitor provider credentials and manage compliance. We provide healthcare organizations with tools to manage and track credentialing processes more effectively and ensure compliance with regulatory and quality standards.

Compliance Begins With You

MedTrainer offers a comprehensive package, including credentialing services, training, and compliance tools. With access to almost 1,000 training courses and onboarding paths, as well as compliance management tools such as incident reporting and contract management, healthcare organizations can ensure that they comply with regulatory standards and deliver the highest quality of patient care.

Contact us today for more information on MedTrainer’s management programs and our physician credentialing services.