Why credentialing is the nightmare you never knew you had

Your patient population is booming. You’ve had to hire a new physician and a nurse practitioner just to keep up with the demand, yet you have more outstanding claims, rejections and write-offs than ever before. How can this be? Unfortunately, increased denials and lost revenue can be the main results of poor credentialing management.

Let’s go back to the beginning. When you decided to hire your new provider, how soon after the ink on the contract was dry did he start seeing patients?  If you’re running a busy practice, chances are that there wasn’t much time to waste. In fact, in our experience, we’ve seen that the average time between hiring a physician and his first day on the job is usually 1 month or less – usually just enough time to take a few weeks’ vacation before starting a new job, or relocating from out of state.  Tip #1 – the least amount of time required to completely credential a provider with the various list of payors in any given area is 2 months – and that’s if the provider is already enrolled in those insurances and you only need to “link” him to your new Tax ID.  If you’re recruiting a provider from out-of-state, or he just graduated from medical school, the whole credentialing process can take upwards of 6 months! That requires a lot of forward thinking on the part of the hiring practice.

“Can’t I just bill my new provider’s services under another member in the group until his credentialing is complete?”  The simple answer to this question is ‘no’.  There are many reasons our billing and auditing specialists can give you that will help explain why this is never a good idea.  “What about our new nurse practitioner? It must be quicker to get a non-physician credentialed with the health plans.”  Tip #2 – see Tip #1!  In most cases, the credentialing and contracting of a non-physician takes just as long as a physician.

Don’t keep spinning your wheels and getting nowhere. Hire a credentialing specialist and maximize your reimbursement potential!