What Factors Influence the Cost of Medical Credentialing Services?

One of the most significant procedures that a health care provider needs to cut through is medical credentialing that enables it to offer its services to patients who are undergoing insurance programs. That is how practitioners are confirmed as doctors, nurses and clinics by the insurance companies which demands them to meet the befitting requirements of licensure, education and professionalism. One of the most common questions that a number of providers inquire is as follows: How costly is credentialing?

It is not always black and white. Medical credentialing services are priced based on various important factors such as the number of providers to specialty and even the speed at which you want the job done. In this blog, we will unravel the factors that influence the prices of credentialing, how much you have to pay, and how much you can save on the cost without adversely affecting its accuracy.

Why Is Credentialing So Important?

Credentialing is a process that covers the fact that healthcare providers are adequate by insurance companies, government agencies, and licensing boards. You cannot be included in insurance panels, not billed by the payers (Medicare or Medicaid), and develop a desired patient trust without proper credentialing. You may end up being delayed in receiving your revenues or even being penalized because of not filing to get credentialed in the first place and hence meeting legal and other penalties.

Credentialing is also the matter of:

• Reimbursement: Insurers will not reimburse you in a case of non-credentialing.
• Legal Compliance: The majority of payers stipulate legally that verification is mandated.
• Network Participation: Participation in the networks of the insurers is possible through credentialing, thus you become more visible to the patients.
• Reputation & Trust: Patients and referring providers are interested in confirmation that you are trusted and can be verified.
  

Having established the importance of this discussion, we may analyse what factors affect the cost of credentialing.

Main Factors That Influence Credentialing Costs

Type of Provider (Individual-Group)

A solo practitioner credentials are usually cheaper compared to a group practice. Group credentialing is multi-application, data coordination and is time consuming adding to the cost.

Amount of Providers Credentialed

In case it is one provider that you are credentialing then your expense could be a single fee. However, in the case of several clinicians, the cost escalates. Other credentialing services will charge per provider, and others will have volume discounting prices.

Specialty of Practise

Credentialing costs in specialized areas such as behavioral health, surgery or radiology can be substantially greater because of the degree of verification needed. Such applications can be more reviewed, followed up and filled.

State Requirements and Payer Requirements

Depending on the state and on the insurer, credentialing regulations vary. As a random example, fingerprinting or some other extra forms may be required to apply to Medicaid in one state and not another. This may affect working time and the administrative complexity which increases the cost.

Manual vs automated Process

The manual credentialing activity is expensive to perform since it involves human labor to input the information, filling the forms, and making the follow-ups. Alternatively, this could be alleviated by tools such as CAQH ProView or automated credentialing systems that could provide efficiency and cheaper pricing.

Type of Credentialing (Initial vs Reccredentialing)

The initial credentialing often costs as well as time more than again doing credentialing which is necessary after 2-3 years with each payer. However, again doing credentialing is cheaper even though verification, updating documentation and portal submissions are made.

Time/Sense of urgency to finish the work

When your credentialing must be completed within some relatively short time-frame like perhaps in 30 days. You can be sure of paying some rush or expedited fees. Normally the procedure of credentialing takes 60-120 days, however, expediting the procedure includes more hours and usually additional fees.

Outsourced credentialing vs In-House credentialing

In-house credentialing might look less costly, but think of the salaries of staff members, training, and software, as well as the risk of delay. Contracting with a certifying outfit is a way to save time and expensive mistakes, although it involves additional charges in the form of service fees.

Technology Channel Utilized

Credentialing companies using newer platforms such as CAQH, PECOS and integrated EHR credentialing tools can be more cost-effective or efficient. Tech-enabled services minimize hand work and in other instances, your cost per application is lowered.

Follow-ups and Repair Works

Credentialing is not a set it and forget it. It must be updated continuously and there is constant tracking of expiration dates (medical license, malpractice, DEA) and periodic re-enrollment of the contract as it expires. There are services that are charged additional fees to maintain and remind.

Denial/Rework Processing

Not all the applications pass the first time round. An application that is rejected or delayed will need rework, corrections and follow-ups. Providers must question the vendors on whether the handling of denials are part of the base fee of the vendor, or it is an extra.

Support and Consultation are Included

The world of credentialing is a confusing one. Other services provide a support team, phone consultations or a review of contracts. Such value added services can have an initial high cost but higher efficiency and success rate.

Average Cost Ranges for Medical Credentialing

Precise prices depend on which service provider and scope of service is sought, but generally, most credentialing services are priced at one of the following industry rates:

• Between 200 -500 dollars per person initial credentialing
• Between $100 and 300 on again credentialing
• Group practice or multi-provider arrangements

Other agencies have monthly packages, which offer regular updates, communications with payers as well as compliance services to clinics with multiple providers.

Watch out pink fees, that is:

• Urgent/ rush charges
• Rework fee charges
• NPI registration or CAQH profile set up fees
• PECOS or Medicaid enrollment assistance costs

Never forget to ask an itemized quote to prevent surprises.

Why Understanding Credentialing Costs Helps You Choose the Right Service

Credentialing is not merely an administrative one-time activity; the credentialing is an investment made in development of the practice and financial health of your practice. The knowledge of what enhances the cost of medical credentialing services assists you. These are as:

• Compare the vendors with wisdom
• Escaping underpricing traps
• Order quicker payer approvals
• Maximization of the long term ROI

Search agencies who have openness, practice experience in your specialty, good payer relationships and responsiveness. Speaking of which, a marginally increased fee can keep you thousands of dollars ahead by avoiding rejections of claims and loss of revenue.

Conclusion

Credentialing is not simply a checklist; in fact, it is the key to payer enrollment, patient access, and receiving prompt reimbursements. Prices change according to a number of factors. But I can assure that you can manage to reach a certain price by doing smart planning so as to eliminate avoidable delays.

The amount of providers, your state and specialty, all of these are known to be cost drivers that you should consider as you make your choice in selecting a credentialing partner. Either that you have it done in-house or outsourced, make sure it is done in the best quality, with highest precision, and fast enough that you remain in compliance and remain profitable.

FAQs About the Cost of Credentialing Services

1. What is the usual cost of credentialing?

The pricing charged tends to average out at 200 to 500 dollars per application per provider and up to 2,000+ to group practice. Recredentialing is cheaper.

2. Of all the secrets of the provider credentialing, what are the hidden charges?

Hidden fee may come in the form of an urgent processing fee, covering rework due to denials, NPI registration, CAQH set up or document retrieval fees.

3. Is in-house credentialing cheaper to do?

In-house credentialing seems to be less costly, but it is susceptible to hidden labor costs, leakages and compliance risks. It is possible, through outsourcing, to save time and limit the number of mistakes.

4. Is automation offering a possible solution to the cost of credentialing?

Yes. Through applications such as CAQH ProView and auto credentialing worksheets, manual inputs can be diminished, the speed of the process will be generally faster, and the costly errors will be avoided.

5. What kind of provider again credentialing frequency is required?

Insurance companies (majority of them) demand recredentialing after every 2-3 years. The updates maintain the active nature of the network and non-interruption of the payment.