Cost Comparison: In-House vs Outsourced Credentialing Services

Credix Healthcare is the most outstanding credentialing firm to the healthcare providers. We assist doctors, clinics, and solo practitioners to administer their credentialing in a fast and accurate way. Regardless of whether your practice is large or you practice independently, you should become credentialed with insurance payers. However, there is always this big question which arises; do you do your credentialing in-house or do it through professionals?

Today, on this blog we will discuss the actual cost of in house and outsourced credentialing. We will check out the cost, advantages and disadvantages and a scenario where one should use either of the two. When you have read to the end you will be aware of which course best suits your pocket and practice.

What Is In-House Credentialing?

In-house credentialing implies that enrollment of the providers in insurance companies is made by your own staff. This may be done by someone in your front office or you can hire a full time credentialing specialist. This individual deals with all the paperwork collecting documents, completing forms, staying on top of payer requirements, and following the process of application success.

When you do credentialing in house, you are the boss. You know what the person is doing, and you are able to closely follow the work. However, that control needs more responsibility, time and in some cases, more expenses. It does not require only a couple of forms to be filled in. Credentialing takes a long time and involves a lot of back and forth. 

What Is Outsourced Credentialing?

Contracting the credentialing process is the ability to employ a business such as Credex Healthcare to take on the entire process. We do all the CAQH set up, insurance enrollment, document review and follow ups. There is no need to be afraid of a race against due dates and knowing all the rules of all the payers. All the heavy-lifting is done by us.

Outsourcing is time saving and prevents delays that are costly. It is also cost saving when done correctly. That is when the credentialing cost analysis comes in. You need to know whether the money you spend on outsourcing is worth it in comparison with how long it will take and how much it will cost you to get the same job done yourself.

Credentialing Cost Analysis: Breaking It Down

Then a word about the money. When credentialing is kept in-house you must have some full-time employee who will perform a credentialing role or delegate to an existing employee. Without having been trained, errors are likely to occur in such a person. Extra time can cause rejection of claims and loss of income.

The in-sourced credentialing staffing expense accumulates. It eats into salaries, training, uses of software tools and error-fixing time. Your staff may have lots of things to do in a busy practice, and credentialing may be only one of them. That causes burnout and lapses.

Outsourcing medical credentialing, however, is done on a flat fee basis, or on a monthly basis. This expenditure is foreseeable. Through Credex Healthcare we will be providing clear prices which is what you should be expecting. No cowboy fees, and no hidden charges.

When Does In-House Credentialing Make Sense?

In house credentialing This is acceptable when you already have a credentials coordinator who is experienced. It may also work with a small practice that does not do a lot of work with insurance payers.

Nevertheless, you should take into account the time required. Credentialing is not a one time event. You should maintain CAQH profiles, address re-credentialing requests, and stay on the deadlines of payers. A single mistake may result in delays of the payments or even the loss of the network participation.

It may appear that it is better to have in-house especially to practices that are still new and faced with financial constraints. The expense of the concealed costs in even little clinics accumulate quickly. This is why a complete credentialing cost analysis is a smart thing to do prior to making a decision.

When Should You Outsource Credentialing?

Outsourcing is always a good option in case you desire to be at rest and professional work. Outsourcing is wiser when you are expanding your practice, have a large number of payers to work for or, simply, lack the time to handle it yourself.

Credex Healthcare is speedy, cheap, and precise concerning credentialing services. We are aware of the top to bottom enrollment services of providers. We have our specialists following each detail and you need not do it. And on top of that, we monitor the payer rules changes so you evade getting out-of-network and non-compliant.

What’s the Real Cost Difference?

Are we going to scrutinize some actual figures? To employ a full -time credentialing personnel may cost up to 40,000 to 60000 yearly. The training or credentialing software is not there. Error is probable given that that staff might have to do other things.

This is in comparison to outsourcing the medical credentialing. Using Credex Healthcare, you may end up paying something like 300 to 500 dollars per provider full-service credentialing. That comprises the enrollment process of insurance, CAQH, re-credentialing, and follow-up. The price remains fairly steady and manageable when it comes to the monthly maintenance.

This will make a tremendous difference over the tenure of in house vs outsourced credentialing cost. You do not only save money but time and stress. And that is time that is valuable. The more quickly you get credentialed the quicker you can charge and be compensated.

ROI of Professional Credentialing Services

View credentialing like it is an investment. Effective credentialing will amount to added money. Each week a provider is not credentialed and you are not receiving payments. It may cost thousands of dollars a month.

Credex Healthcare makes you credentialed quickly. It translates to you being able to bill earlier. We validate all of the information to prevent refusals and postponements. That is a good investment payoff.

You minimize risk when you outsource as well. You do not have to fear missing any re-credentialing schedules or compliance. It is economical in the long term.

Picking the Right Credentialing Option

Whether to use an in-house approach, or outsource this credentialing option depends on the size of your practice, budget, and objectives. In-house would work in case you are certain that your team is capable of dealing with it, and the number of payers that you are using is small as well. However, in the case that you desire speed, precision and increased flow of revenue then outsourcing is the superior choice.

Credex Healthcare is a leading credentialing service provider in the country. We have assisted thousands of providers to be enrolled with large insurance companies. We are trusted due to being fast, friendly, and transparent by our clients.

We can also give you a detailed provider enrollment services comparison, in case you are still doubting. We will assist you to get the most economical solution.

FAQs

Can credentialing be done more cheaply within a company?

It is a matter of your setup. The in- house may be considered economical, but is going to be more expensive in the long-term. There is potential loss of revenue due to staff training, errors and delays. Outsourcing provides certain costs and professional services.

What are the advantages of credentialing outsourcing?

You will save your time, make less mistakes, and obtain a quicker outcome. There are firms such as Credex Healthcare that do the process fully. It means that you continue practicing or concentrate on the health of the patient and we deal with your documents.

What is the formula to compute credentialing ROI?

Take the time on credentialing marks to initial payment. Contrast outsourcing expenses (flat rate) to in-house expenses (salary, software and delays). A shorter turnaround credentialing translates to a shorter turnaround payment and an increased ROI.