Before your practice can get paid for your providers’ services, those clinicians must go through the payer enrollment process, which has multiple credentialing steps that can take upwards of six months to complete. And every day of delay when your providers aren’t credentialed means you’re losing money. The solution for many practices is delegated credentialing.
Check out a few key facts about delegated credentialing to determine whether it might be a viable solution to help your practice bring in cash faster and more efficiently.
Delegated Credentialing Can Speed Approvals
In delegated credentialing, the health plan gives credentialing authority to another health care entity, allowing the process to move more quickly (in some cases, completing the process in 30 days or less). The delegated organization reviews the provider’s qualifications and makes credentialing decisions on behalf of the health plan.
You cannot simply delegate the credentialing function to anyone, however. The delegated health care entity must be pre-approved to perform delegated credentialing by the actual health plan. In some cases, an external credentials verification organization (CVO) can serve as the credentialing party, because CVOs are approved by some health plans to perform primary source verifications and credential providers.
Calculate Pay Implications
If you’re considering working with a CVO to get your providers credentialed faster, it can be helpful to calculate what the payment implications might be to process your enrollments more quickly.
Here’s how: Suppose your provider is scheduled to start seeing patients January 1, but he isn’t approved by the insurer until March 1. You just lost 43 business days in revenue. Let’s say, conservatively, that this provider would have seen five patients per day, and that each patient is worth $100 in revenue. This means you lost $500 per day for 43 days, which comes out to $21,500 in lost revenue during that period.
Free up Office Staff Time
In addition to saving you time on credentialing and allowing you to bring in cash faster, delegated credentialing can release your office staff members from performing enrollment tasks, thus freeing up more time for them to do other responsibilities, like following up on denials or performing self-audits.
Some practices also see higher patient satisfaction numbers after moving toward delegated credentialing. Why? Because it makes more providers available for patient appointments, allowing for shorter wait times and more streamlined appointments.
There’s much more to know about delegated credentialing, and expert Tammy West, MHA/ED, CPMSM, CPCS, is here to help. During her online training event, Delegated Credentialing: Tactics to Speed Enrollment & Payments, Tammy will provide you with the plain-English tips you need to get your providers onboarded with insurers faster so you can start bringing in reimbursement more swiftly. Register today!
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