- Credentialing, payor enrollment, and contracting can drain far more time and financial resources than healthcare organizations anticipate when handled internally.
- Providers not equipped to manage these services in-house risk inaccurate credentialing data, longer accounts receivable days, more claim denials and non-participating providers, frustrated staff, and failure to achieve accreditation.
- Choosing the right partner means evaluating the vendor’s expertise, technological solutions, and proven track record, and conducting a risk analysis to confirm the decision fits the organization’s needs.
- A vetted partner brings credentialing expertise, gained efficiencies, and advanced automation that tracks expirables and manages workflows through a customizable interface while maintaining data accuracy, security, and compliance.
- Engaging an external partner reduces labor and training costs, frees staff for meaningful work, and gives the organization the flexibility to scale up or down as its customer base and regulatory environment change.
When healthcare organizations and providers try to take on the complex tasks of credentialing, payor enrollment, and contracting, it can be a drag on time and financial resources — sometimes much more than they anticipate. As a result, many look to engage an external partner for these services. Careful assessment is necessary in making this decision and selecting a third-party vendor that is the right fit. This involves evaluating the vendor’s expertise, technological solutions, and track record, among other factors. Those ready to move forward stand to achieve many benefits.
Adverse outcomes of managing credentialing in-house
For some healthcare providers, it might make sense to manage these services internally. The decision often comes down to available resources and how simple or complex the need for credentialing, payor enrollment, and contracting actually is. Each organization should run a risk analysis to determine whether engaging an external RCM partner makes sense.
One thing, though, is sure: those not equipped to manage these services in-house can suffer severe negative business outcomes that include:
- Inaccurate credentialing data that leaves a practice vulnerable to risk.
- Increased days of invoices sitting in Accounts Receivable (AR).
- Increased claim denials and non-participating (non-PAR) providers.
- Poor customer experience and frustrated staff.
- Failure to achieve accreditation and damaged reputation.
Engaging an external partner for these services helps providers avoid these pitfalls by removing the administrative and management burdens from staff so they can focus on value-added tasks. While there are upfront costs, providers who take the time to evaluate their needs and select the right credentialing partner can save money in the long run, retain workers, and improve the patient experience.
Four benefits providers gain from the right partner
1. Improved expertise
When a provider contracts with a third-party vendor that has been properly vetted and has a proven track record, it no longer has to struggle with the day-to-day headaches of managing credentialing processes. Instead, the provider can rely on experts with the know-how and experience to navigate complex requirements. This expertise enables healthcare organizations to stay up to date on evolving regulations and standards and to maintain data accuracy across intricate credentialing requirements.
2. Gained efficiencies
By leveraging the expertise and technological solutions of a credentialing services vendor, providers can accelerate credentialing, enrollment, and contracting to speed up payments, reduce workflows, improve profitability, and enhance the customer experience.
3. Innovative technology and automation
Partnering with a credentialing vendor gives healthcare providers access to advanced, robust automation tools that streamline processes and can be implemented in a relatively short time frame. The solution can track expirables and manage workflows — all through a customizable, user-friendly interface — while ensuring data accuracy, security, and compliance.
4. Reduced labor costs
One of the most impactful benefits of partnering with a third-party vendor is the time savings, reduced labor costs, and relief from human resources challenges. Through the efficiencies of improved technological solutions, staff are freed to focus on meaningful tasks and patient health, leading to improved retention and reduced labor and training costs.
Long-term, flexible scalability
Perhaps the most impactful and long-term benefit a healthcare organization can realize is the ability to scale the operation to align with its expanding — or sometimes shrinking — customer base. By staying flexible and remaining resilient to unpredictable headwinds in the healthcare industry, providers can prepare for the long term and remain profitable even amid changing and unpredictable credentialing regulations.
The right credentialing, payor enrollment, and contracting partner combines vetted expertise, proven technology, and the flexibility to scale. Talk to our team about evaluating your needs and building a credentialing program that supports growth.
Frequently asked questions
What should you evaluate when choosing a credentialing and payor enrollment partner?
Evaluate the vendor’s expertise, technological solutions, and proven track record, and run a risk analysis to confirm the decision fits your organization’s resources and the complexity of your credentialing, payor enrollment, and contracting needs.
What are the risks of managing credentialing in-house?
Organizations not equipped to manage these services internally can face inaccurate credentialing data, increased Accounts Receivable days, more claim denials and non-participating providers, poor customer experience and frustrated staff, and failure to achieve accreditation with a damaged reputation.
How does a credentialing partner improve efficiency and payments?
By leveraging the vendor’s expertise and technological solutions, providers can accelerate credentialing, enrollment, and contracting to speed up payments, reduce workflows, improve profitability, and enhance the customer experience.
What role does technology and automation play in credentialing?
A credentialing vendor provides advanced automation tools that can be implemented in a relatively short time frame, tracking expirables and managing workflows through a customizable, user-friendly interface while ensuring data accuracy, security, and compliance.
Why is scalability an important benefit of a credentialing partner?
A partner lets a healthcare organization scale its credentialing operation up or down to match an expanding or shrinking customer base, staying flexible and resilient so the organization can remain profitable amid changing and unpredictable credentialing regulations.