Thoracic surgery is one of the most demanding and worthwhile surgical specialties in medicine. Thoracic surgeons operate on hearts, lungs, and major chest vessels; they treat the two leading causes of death in America, heart disease and lung cancer. Due to the sensitivity of this medical specialty, there is no room for credentialing delays. However, many thoracic surgeons face delays in credentialing, and the process can stretch for months, which bottlenecks their ability to operate and bill for complex procedures that patients urgently need. 

 Thoracic surgery credentialing is more complex than almost any other medical specialty. You require hospital privileges at advanced surgical centers and significant fellowship training verification for board certification. Multi-hospital practice requires coordinating credentialing procedures simultaneously. Effective medical credentialing companies for thoracic surgery handle the credentialing process and protect patient care and practice income. 

 What is Thoracic Surgery Credentialing? 

Thoracic surgery credentialing is a verification process confirming qualifications, training, and professional history for operating in hospitals and billing insurance. This process includes verifying medical school graduation, residency completion, fellowship, board certifications, state medical licenses, DEA registration, and malpractice insurance. 

Credentialing for thoracic surgeons involves additional verification of surgical training through competency case logs in areas like cardiac procedures and thoracic oncology. Peer references from other cardiothoracic surgeons are required to attest to surgical skills and judgment. Board certification verification through the American Board of Thoracic Surgery ensures specialized training and ongoing competency. 

Credentialing committees at hospitals review applications to determine surgical privileges. Insurance credentialing follows hospital privileging, requiring enrollment with Medicare, Medicaid, and commercial payers, each with unique processes and documentation requirements. Payers generally access the CAQH profile for basic information but still require specific applications for approval on insurance networks. 

Why Credentialing is Critical for Thoracic Surgeons 

To properly practice thoracic surgery and charge for it, you must have valid and duly recognized credentials. Hospitals need them to grant you operating room access and surgical privileges. Registering customers and correctly adding source information, is an important step in the credentialing process that is often considered for application approval. It takes a long time to get credentialed, which has a big financial effect on lung doctors. They can lose hundreds of thousands of dollars in possible income when surgeries are delayed. 

When there are delays in credentialing, surgery teams cannot do anything, they lose time in the operating room, and patients must wait for important surgeries. Taking too long to recognize someone can hurt your professional image. This delay in recognition can cause doctors to lose trust in you and frustrate patients, potentially leading them to seek care from competitors instead. Even after certification is finished, it can take years to fix the damage to the image caused by these delays. 

Common Credentialing Challenges in Thoracic Surgery 

Credentialing for thoracic surgery is very complex and requires extra vigilance in application submission along with effective follow-ups. Following are some of the common credentialing challenges thoracic surgeons face.  

Complex Training Verification

Thoracic surgery necessitates extensive training verification, including 2-3 years of cardiothoracic fellowship after medical school and general surgery residency. Credentialing committees must validate every training phase by contacting various  

program directors and institutions for confirmations and evaluations. 

Multiple Hospital Affiliations 

Thoracic surgeons often hold privileges at multiple hospitals, each specializing in different areas. Each hospital requires individual credentialing, which complicates managing different schedules and documentation demands. 

Subspecialty Documentation

Credentialing must accurately reflect the surgeon’s subspecialty expertise. For instance, thoracic oncology specialists need evidence of training in lung cancer surgery, while congenital cardiac surgeons must provide documentation of pediatric cardiac rotations. 

Equipment and Facility Requirements

Cardiac surgeons require hospitals with specific capabilities, such as cardiopulmonary bypass and specialized ICUs. Additionally, surgeons conducting robotic procedures must complete separate credentialing processes for the robotic systems used. 

How to Choose a Thoracic Surgery Credentialing Company 

When evaluating credentialing partners for your thoracic surgery practice, prioritize companies with demonstrated surgical specialty experience.  

• Inquire about the credentialing process for cardiothoracic surgeons and the number of thoracic surgeons who have received credentials in the past year.  

• Look for companies that know about thoracic surgery and how to get trained and certified in subspecialties.  

• Look for companies that have credentialing specialists who will personally handle applications to ensure they are correct and to avoid misunderstandings, especially when working with more than one hospital and insurance company.  

• Check out the credentialing company’s hospital experience, paying special attention to how well they can work with medical staff offices, write privilege delineation requests, and proceed through the credentialing committee process quickly.  

• Find out how well the company works with hospital credentialing bodies and how often they obtain surgical privileges without any problems. 

• Evaluate the technology and communication systems for real-time visibility into the status of credentialing applications, including updates from hospital committees and insurance processors. 

• Look for online portals or regular status updates to minimize disruption to surgical schedules.
  Compliance risks escalate when surgeons try to work around credentialing delays. To avoid these risks, an effective credentialing is essential for thoracic surgeons. Following medical credentialing companies for thoracic surgery ensures faster turnaround time with professional expertise.  

Credex Healthcare 

Credex Healthcare brings extensive experience serving surgical specialties across the United States, with particular strength in complex surgical credentialing like thoracic surgery that demands both hospital privileging and insurance enrollment expertise. Their personalized approach assigns dedicated credentialing specialists to each surgeon, ensuring someone who understands your cardiothoracic training manages all your applications consistently.  

Credex handles hospital credentialing, Medicare and Medicaid enrollment, commercial payer credentialing, CAQH management, and ongoing recredentialing for thoracic surgeons operating at single or multiple facilities. Their HIPAA-compliant methods and data security secure thoracic surgeons’ credentials and personal information throughout enrollment. 

MedCare MSO 

MedCare MSO has a high success rate nationally at licensing and registration for healthcare providers. They have worked in all areas of surgery and are especially knowledgeable about billing and licensing for lung surgery. MedCare MSO keeps an eye on credentials all the time so that you do not miss any.  

This is very important for chest surgeons because they need to be able to operate at any time to make sure that there is always someone available for emergency heart surgery. For lung doctors of all experience levels, they do initial credentialing, keep track of application, manage revalidation, and handle premium network registration. 

Practolytics 

Practolytics uses technology to automate part of the credentialing process and add human expertise to the mix. Their specialty-specific credentialing routes have specialized cardiovascular and thoracic surgery processes that take into account resident training proof, subspecialty licenses, and complex hospital privilege delineation. 

Practolytics is great at handling cardiothoracic doctors who work at more than one hospital or surgery center. It quickly lines up credentialing at all sites. Their active follow-up and progress tracking ensure that lung doctors get information on time during long credentialing processes. 

Verisys 

Verisys brings enterprise-level expertise perfect for teaching medical centers and health systems employing multiple thoracic surgeons. Their knowledge of the field is great for college medical schools and health systems that have more than one lung surgeon. They keep both NCQA and URAC certifications, which means that provider data verification credentials for lung surgeons are verified.  

With automated verification processes, Verisys constantly checks licenses, credentials, and penalties. This keeps the credentials of all cardiothoracic surgeons up to date across all hospitals and payers at the same time. 

National Credentialing Solutions (nCred) 

nCred offers thoracic surgeons real-time application tracking through their proprietary platform, eliminating constant phone calls to check credentialing status. Their platform uses technology and skilled staff to get things done quickly and provide the medical licensing knowledge that every thoracic surgery needs. 

nCred works with people around the country and knows how hospital clearance standards and state licensing requirements for lung doctors can change from place to place. For cardiothoracic doctors working in one or more states, they help with hospital privileges, all-payer credentialing, CAQH management, and Medicare/Medicaid enrollment. 

CureMD 

CureMD has earned recognition for significantly reducing credentialing timelines, cutting typical months-long processes to weeks, which is critical for thoracic surgeons urgently needed by understaffed surgery programs. Their license and certification management ensures thoracic surgeons’ credentials stay current without lapses that could interrupt emergency cardiac surgery call coverage.  

CureMD’s active application management maintains constant communication with hospital credentialing companies and insurance companies, proactively following up to prevent delays that commonly extend thoracic surgery credentialing beyond reasonable timeframes. 

Transcure 

Transcure has professional credentialing professionals who know all the ins and outs of credentialing for surgery specialties, especially when it comes to cardiothoracic treatments. They work with more than 500 providers and keep 99% of their clients each year. Transcure provides credentialing services and medical billing assistance that are specific to thoracic surgery.  

They take care of Medicare and Medicaid revalidations in a proactive way, make sure CAQH profiles are up to date, and make it easy for lung doctors with unusual hours to get in touch with them at any time of day or night. 

Physician Practice Specialists (PPS) 

PPS has certified more than 50,000 providers in all 50 states, giving them experience that no other organization can match. PPS, which is led by former practice executives, knows how hard it is for thoracic surgery programs to find surgeons who can meet the community’s cardiac care needs.  

The professional credentialing specialists know a lot about the billing codes and paperwork that are unique to thoracic care. PPS offers more than just basic credentialing for new businesses. This service is especially useful for people who want to start new thoracic surgery programs or add new facilities to their existing cardiothoracic services.   

MediBillMD  

MediBillMD helps doctors get their medical credentials and sign up as providers in more than 45 specialties, such as thoracic and cardiothoracic surgery. The company is based in Dallas, Texas, and it protects provider data by following ISO-certified and HIPAA-compliant procedures. 

They have a percent-based pricing model, which can be helpful for thoracic surgeons who are starting new practices. Their credentialing specialists handle the requirements for payer enrollment, with each provider assigned a dedicated account manager. Their team stays up to date on insurance rules in each state, which helps with enrollment in insurance panels across the country.  

US Global Medical Billing Services 

US Global Medical Billing Services offers nationwide provider credentialing and insurance enrollment, with transparent and the lowest pricing per application. Their credentialing team follows a structured seven-step process, including CAQH setup, payer follow-ups, and recredentialing management. All credentialing workflows are HIPAA-compliant, supported by data security measures such as non-disclosure agreements and routine compliance audits. 

Credentialing & Enrollment Services for Thoracic Surgeons 

When professional credentialing companies work with lung surgeons, they make sure that all documents are in order. These companies check qualifications with original sources instead of copies given by the surgeon. They help people sign up for both government and private insurance plans. For Medicare and Medicaid, specifically, they follow certain paperwork rules and handle applications for different private insurance plans.  

The Council for Affordable Quality Healthcare (CAQH)provides a platform for records that credentialing companies keep up to date. This makes sure that the paperwork shows the right licenses and qualifications. These companies also make sure that surgeons do not lose their credentials by constantly recredentialing and revalidating them. 

Hospital Privileging & Surgical Compliance 

Hospital privileging is important for lung doctors because they need the hospital’s permission to do any surgeries. Credentialing companies make this process easier by putting together detailed forms that list down all the surgeon’s training and experience in medical school, residency, and fellowship. They make sure that all the paperwork follows hospital rules, keep track of surgery cases, and get references from other doctors. 

It is important to work with the hospital’s medical staff offices to make sure that the licensing group has everything they need to review applications. This is because even small mistakes can make evaluations take a month longer. Credentialing companies that have been in the field for a long time know what each hospital needs. They also make sure to clearly spell out what each surgeon can do based on their training and experience with all types of chest surgery. 

In healthcare, compliance management means that you have to keep renewing your medical licenses, board certifications, legal insurance, and DEA registrations all the time. Credentialing companies keep track of expiration dates and help people get extensions on time. They also make sure that the rules for billing and HIPAA privacy are followed.  

Thoracic Surgery Credentialing Costs 

The credentialing process for thoracic surgery incurs various costs, primarily influenced by its complexity and geographic range.  

Initial Charges 

The initial credentialing charges usually range between $500 and $1,000, whereas insurance companies may bill $200 to $500 for each credentialing case. Surgical professionals typically find themselves needing to work with around 10 to 15 insurance providers. This often results in Medicare credentialing fees that range from $150 to $300, while Medicaid costs can differ depending on the state. The total expenses for obtaining approval at various hospitals typically fall between $5,000 and $15,000.  

Ongoing Costs

Monthly fees ranging from $300 to $600 for the maintenance of CAQH updates, expiration tracking, and recredentialing. This ensures that credentials remain current without placing a burden on key office staff. Numerous thoracic surgeons discover that outsourcing these processes tends to be more cost-effective compared to hiring internal staff. 

FAQs About Thoracic Surgery Credentialing 

How long does thoracic surgery credentialing take?
Complete credentialing typically takes 120-180 days for hospital privileges and payer enrollment combined, although experienced credentialing teams can sometimes reduce this to 90-120 days. 

What boards are required for thoracic surgeons?
Thoracic surgeons need American Board of Surgery certification in general surgery plus American Board of Thoracic Surgery certification, both requiring initial certification and ongoing maintenance. 

Do thoracic surgeons need separate hospital privileging?
Yes, each hospital requires separate privileging applications, credentialing committee approval, and specific privilege delineation for cardiac and thoracic procedures you’ll perform. 

Is credentialing different for cardiothoracic surgery?
Yes, cardiothoracic credentialing requires extensive additional documentation, including fellowship training verification, subspecialty certifications, surgical case logs, and peer references from other cardiothoracic surgeons. 

Can credentialing be outsourced for surgical practices?
Yes, most thoracic surgery practices outsource credentialing to specialized companies that complete the process faster and more accurately than in-house administrative staff can manage. 

Conclusion 

A surgeon’s credentials have a big impact on how well they do. These qualifications affect their revenue, patient service, and interactions with insurance companies. It is hard for surgical clinics to manage their processes. The extra workload makes it harder for them to handle these processes properly. This responsibility takes time away from their main professional duties. Careful medical credentialing is essential in the high-stakes field of surgery to ensure patient safety, legal compliance, and seamless operations. 

Professional credentialing companies handle all the documents on your behalf so you can focus on providing lifesaving heart and lung surgery. Hospitals and surgical credentialing experts like Credex Healthcare built an understanding of quick and effective workflows, which helps thoracic doctors get started sooner. Choose a credentialing partner that understands the unique issues in thoracic surgery and can meet the tricky needs of hospitals and insurance companies right away.