Cost Comparison: In-House vs Outsourced Credentialing Services

Credex Healthcare is the top credentialing firm for healthcare providers. We help doctors, clinics, and solo practitioners manage their credentialing quickly and accurately. Whether your practice is large or you work independently, getting credentialed with insurance payers is essential. But the big question is: should you handle credentialing in-house or outsource it to professionals?

Today, in this blog, we will examine the true costs of in-house versus outsourced credentialing. We will examine the costs, advantages, and disadvantages, as well as a scenario where one option might be better than the other. By the end, you’ll know which approach best fits your budget and practice.

What Is In-House Credentialing?

In-house credentialing means that your staff handles enrolling providers with insurance companies. This can be managed by someone in your front office or by hiring a full-time credentialing specialist. This person manages all the paperwork, gathers documents, completes forms, stays updated on payer requirements, and oversees the application process. 

When you handle credentialing internally, you retain control. You know what the person is doing, and you can closely monitor their work. However, this control comes with more responsibility, time, and sometimes additional costs. Credentialing involves more than just filling out a few forms; it takes a significant amount of time and involves a lot of back and forth.

What Is Outsourced Credentialing?

Contracting the credentialing process means hiring a business like Credex Healthcare to handle the entire procedure. We take care of all the CAQH setup, insurance enrollment, document review, and follow-ups. You don’t need to worry about racing against deadlines or mastering the rules of all payers. We do all the heavy lifting.

Outsourcing saves time and helps avoid costly delays. It can also save money when done properly. That’s where the credentialing cost analysis comes in. You need to determine whether the money spent on outsourcing is justified compared to the time and expense of doing it yourself.

Credentialing Cost Analysis: Breaking It Down

Then a word about the costs. When credentialing is done in-house, you need a full-time employee to handle the credentialing or to delegate the task to an existing staff member. Without proper training, this person is likely to make mistakes. Extra time spent can lead to claim rejections and income loss.

The expense of in-house credentialing adds up. It affects salaries, training costs, software expenses, and time spent fixing errors. Your staff might already be busy with many tasks, and credentialing may be just one of them. This can lead to burnout and mistakes.

On the other hand, outsourcing medical credentialing is usually billed on a flat fee or a monthly basis. This cost is predictable. Through Credex Healthcare, we provide transparent pricing, which is what you should expect, with no hidden fees or surprise charges.

When Does In-House Credentialing Make Sense?

In-house credentialing is acceptable when you already have an experienced credentials coordinator. It may also work for a small practice that does not handle many insurance payers. However, consider the time involved, as credentialing is not a one-time task. You need to maintain CAQH profiles, handle re-credentialing requests, and meet payer deadlines. 

A single mistake could cause payment delays or even loss of network participation. It is better to keep credentialing in-house, especially for new practices with financial constraints. The hidden costs in even small clinics can add up quickly. That’s why conducting a thorough credentialing cost analysis before making a decision is a smart move.

When Should You Outsource Credentialing?

Outsourcing is always a good option if you want to relax and focus on professional work. Outsourcing is wiser when you’re expanding your practice, have many payers to serve, or lack the time to handle it yourself. 

Credex Healthcare is quick, affordable, and accurate when it comes to credentialing services. We understand the complete enrollment process for providers, and our specialists handle every detail so you don’t have to. Additionally, we monitor changes in payer rules to help you avoid out-of-network issues and non-compliance.

What’s the Real Cost Difference?

Are we going to look at some actual figures? Hiring full-time credentialing staff could cost up to $40,000 annually. The necessary training or credentialing software isn’t available. Errors are likely because the staff might need to handle other tasks.

This is compared to outsourcing medical credentialing. With Credex Healthcare, you pay around $300 to $500 per provider for full-service credentialing. This includes the insurance enrollment process, CAQH, re-credentialing, and follow-up. The cost remains fairly consistent and manageable for monthly maintenance.

This can make a huge difference over time in the cost of in-house versus outsourced credentialing. You not only save money but also time and stress. And that is valuable time. The sooner you get credentialed, the sooner you can bill and receive payment.

ROI of Professional Credentialing Services

View credentialing as an investment. Effective credentialing results in additional revenue. Each week, a provider remains uncredentialed and payments are not received, potentially costing thousands of dollars monthly. 

Credex Healthcare makes credentialing quick, allowing you to bill sooner. We verify all information to prevent refusals and delays, making it a worthwhile investment. Outsourcing also minimizes risk, ensuring you don’t miss re-credentialing deadlines or compliance requirements. It is cost-effective in the long run.

Picking the Right Credentialing Option

Whether to use an in-house approach or outsource this credentialing process depends on the size of your practice, your budget, and your objectives. In-house solutions are effective if you are confident your team can handle them and you work with a small number of payers. However, if you need speed, accuracy, and a higher flow of revenue, outsourcing is a better choice.

Credex Healthcare is a leading credentialing service provider in the country. We have helped thousands of providers get enrolled with major insurance companies. Our clients trust us because we are fast, friendly, and transparent.

We can also provide you with a detailed comparison of provider enrollment services if you’re still uncertain. We’ll help you find the most cost-effective solution.

FAQs

Can credentialing be done more cheaply within a company?

It’s a matter of your setup. In-house options may seem economical, but they tend to be more costly in the long run. There is a potential loss of revenue due to staff training, errors, and delays. Outsourcing offers certain cost benefits and professional services.

What are the advantages of credentialing outsourcing?

You will save time, make fewer mistakes, and achieve faster results. Companies like Credex Healthcare handle the entire process. This means you can focus on practicing or caring for the patient while we manage your documents.

What is the formula to compute credentialing ROI?

Take the time to credential the marks to the initial payment. Contrast outsourcing expenses (flat rate) with in-house expenses (salary, software, and delays). A shorter credentialing turnaround leads to faster payments and a higher ROI.