Health and Wellness

Medical Credentialing: Choosing Between Hiring a Specialist or Outsourcing

As a healthcare practice, you want your service to be as efficient as possible. Usually, this means upgrading your technology and hiring the best staff.

Practices and professionals can also choose between outsourcing or keeping services in-house. Tasks like coding, transcribing, and medical billing can be done by a third-party company instead of a staff member.

Medical credentialing is one of the essential tasks that improve patient trust and revenue, it also reduces the risk of medical errors. It might make sense to outsource medical credentialing, but it might be better to hire a credentialing specialist exclusive to your healthcare practice.

Outsourcing and hiring in-house both have their benefits and limitations. Knowing what’s in store with each option helps decide what’s best for your healthcare practice.

What is Medical Credentialing?

Medical credentialing involves objectively assessing a medical provider’s license, experience, and the ability to provide a specific service.

Your practice must complete a credentialing process based on the standards by the National Committee for Quality Assurance. Once you pass the credentialing, you’re qualified to provide healthcare.

A medical credentialing usually follows this process:

  1. Information gathering. A credential specialist gathers the required data from the healthcare practice.
  2. Primary source verification (PSV). The specialist obtains credential and licensing information directly from the agencies that granted the licenses. They may also gather data from a secondary source qualified to provide the information.
  3. Privileging process. The specialist sends the vetted application to the committees of a healthcare practice, who will authorize the process or physician. Depending on the size of the facility, the process might go from a department up to the board of directors.

Passing a medical credential improves a patient’s trust in your healthcare practice. When they know their provider’s qualifications, they’re more likely to open up and disclose information to enhance the quality of your service.

Medical credentials are also essential for insurance reimbursement. States and insurance providers use the credentialing process to see if a medical provider meets their requirements.

Hiring a Credentialing Specialist

If you choose to keep your credentialing in-house, you need to hire a medical credentialing specialist.

Their job is to verify that your healthcare professionals’ certifications, licenses, and the training is updated and compliant with state and federal regulations. They also make sure that your services and facilities meet the required standards set by government agencies.

Their daily responsibilities include:

  • Conducting background checks
  • Contacting licensing boards
  • Maintaining databases
  • Processing relevant paperwork
  • Requesting education details and interview references
  • Reviewing license applications

Credentialing specialists may also assist with hiring new staff to ensure that the applicants meet the necessary credential requirements.

Although your staff can do a credentialing specialist’s daily responsibilities, these can be time-consuming. Hiring someone to address your credentialing needs helps your current staff focus on their own specific roles.

A medical credentialing specialist has the industry knowledge and expertise to make sure your healthcare practice stays compliant. However, they can be expensive to hire.

According to Salary.com, the average annual salary of a credentialing specialist in the US is $40,677. If you have a small healthcare facility and can’t afford to hire and pay the benefits of a specialist, this option isn’t for you.

Outsourcing Medical Credentialing

Several healthcare practices that don’t have a dedicated specialist usually hire a third-party company for their medical credentialing requirements. These third parties typically use high-tech solutions that automate the entire process.

Outsourcing your medical staff credentialing leads to these benefits:

  1. Fewer human errors

Outsourced services lead to a more consistent basis of healthcare activities. With state-of-the-art, cloud-based solutions, you can quickly check for errors and perform real-time background checks.

Credentialing verification organizations also ensure equal and fair treatment of medical professionals in your healthcare practice. Using automated solutions, you can provide a non-biased approach to gathering, reporting, and monitoring credentials.

  1. Cost savings

Moving from a paper-based credential system to a cloud-based solution may seem like an expensive cost. However, it can save you money since it reduces costs associated with file storage. With the money you save from automation, you can direct your budget to other efforts.

  1. Improved efficiency

Outsourced credential specialists have the experience to provide a high level of focus to their work. They also have the software and processes that ensure every medical professional in your practice receives the highest credentialing standards.

Having all your data in the cloud helps you avoid lengthy set-up times. Manual credentialing processes take days to credential a physician. With automated processes, physicians attend to their patients more quickly.

Although outsourcing has its advantages, it may not be cost-efficient for some practices. Hiring a third-party credential specialist requires a monthly subscription fee, so make sure you have the budget to outsource.

Choosing an outsourced credential specialist means you have to take extensive background checks on potential companies to ensure you’ll get the most out of your money.

Running a healthcare practice means making sure that your processes and medical professionals are authorized to perform their tasks. This is why medical credentialing is essential.

Whether you choose to hire a specialist or outsource your credentialing tasks, make sure you know its advantages and limitations to decide on the best solution for your facility.

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