Revenue Cycle Management: Credentialing (Part 2)

If you think of revenue cycle management like building a house, payer credentialing is the foundation. If you can’t get the payer credentialing right, you simply can’t get paid. Keeping your credentialing up to date is imperative to getting you paid for your services.

As a whole, it’s the payer’s role to challenge and manage claims as much as possible, while keeping its subscribers (your patients) happy. Thus, the more they can delay or challenge your claims, the longer the payers can hold the premiums paid by the subscribers. In general terms, the longer the time and the less money the payers have to send you, the more profitable they are. This is simply their job and general fiduciary responsibility to their shareholders.

So, you can see why credentialing is an essential part of revenue cycle management, but how can you best carry it out? Below, we have listed some strategies that we use as a medical billing company. They should help guide you through the messy world of credentialing.

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Create Lists

Credentialing is a long and difficult process. Within one practice you may have a number of physicians who need to be in network with multiple insurance companies. Each physician has their own timeline of reauthorizations. Each insurance company has their own timeline for submissions. How do you stay on top of it all? You make lists.

The first list you will want to make will be for the CAQH, the Council for Affordable Quality Healthcare. For many insurances companies, you must be affiliated with CAQH. Unfortunately, this process can take a lengthy amount of time because the application process requires the insurance companies’ involvement. List your physicians who need to be established with the CAQH. Also, list the physicians who are already established, and their dates of establishment.

List all of your physicians and the dates they need license reauthorizations. List all of your insurance companies, their requirements, and the dates they need submissions. Create a to-do list for all the physicians who need to obtain authorizations and/or reauthorizations. Be sure to also note the dates that credentials need to be renewed.

Create A Schedule

With all of the above information clearly written out, you can create a schedule that will lay out tasks throughout the year. Creating this schedule is very detailed work, and is often an ongoing project, but it is the only way to break down the nightmare of credentialing into a smooth and easy process.

Start with your CAQH lists:

• Put in the dates you will submit a physician for CAQH.
• Put in dates to follow up with the insurance companies who have to complete the application.
• Put in dates of re-attestation for physicians who are already affiliated.

Next, add your physician licenses authorizations and insurance submission information:

• Put in dates physicians need to seek renewals
• Put in a few reminders for physician renewals
• Add the timeline of insurance submission information
• Include insurance follow-ups
• Put in insurance reauthorization dates.

As you can see, scheduling for credentialing is imperative but exhausting. It also never ends. Scheduling out the process is the only way to ease the burden of credentialing.

Keep Chugging Away or Hire a Medical Billing Company

Most physicians will tell you, credentialing is a nightmare, and as a medical business company, we understand your pain. The reason we don’t hate it as much as physicians do is that we actually have time to do it. While we stand by our tips listed above, we aren’t going to lie: your schedule will be full. Your best bet is to keep chugging through the schedule crunched for time or to hire a medical billing company.

Failure to stay on top of credentialing could lead to worse scenarios than late payments. It could lead to a physician’s demise, a practice’s closure, or even a patient’s death. This is because one overlooked credentialing error could result in a physician being allowed to practice on a patient without a renewed license. If something were to go wrong, malpractice lawsuits would be at hand.

Don’t let credentialing overwhelm your practice, causing revenue cycle delays, denied payments, or worse. Get the help you need; hire a medical billing company. Contact MEREM Healthcare Solutions today.