What are Medical Credentialing and Recredentialing Services?
Before you can understand the importance of performing a task or service, it is necessary to first understand why it is done in the first place. Credentialing is the process of evaluating the practice history of a medical provider. It also evaluates the qualifications and training of that provider relating to the services that he or she is being hired to perform. Physicians and other healthcare providers are required to undergo this evaluation in order to meet the needs and legal requirements of medical billing services.
Recredentialing is a process in which the medical provider is re-evaluated. Recredentialing services are typically performed every ten years or can be performed more frequently, as necessary. Fast and accurate credentialing and recredentialing help medical practices and clinics assure safe and high-quality healthcare for their patients. These services are often recommended by or performed by healthcare consultants, as they are extremely important to developing trust between patients and healthcare providers.
How Does Credentialing Work?
One of the reasons why you will often see the term fast and accurate credentialing used, is that anyone who has ever performed credentialing or recredentialing services can tell you, it can be a long, difficult and extremely involved process. If you can find a team that works with medical billing services that also provides fast and accurate credentialing and recredentialing services, you should definitely take advantage of those services. The process involves the collection of data, a primary source verification and a committee review that is performed by health plans, healthcare agencies and hospitals, in which the merit and experience of each provider can be ultimately assured.
Submitting this information by hand can be tedious and frustrating, and a paper-based credentialing process is often required before a health plan is able to contract with the provider. However, it is possible to eliminate the frustration of this type of work by outsourcing medical billing services and healthcare consultants to provide you with fast and accurate credentialing and recredentialing services. These services can often submit electronic credentialing processes to increase efficiency and effectiveness, while maintaining quality and consistency for their clients.
Why Credentialing is Important
A lot of people – even people in the medical billing services field – do not understand why credentialing is so important. Industry leaders have been fighting for the ability to enhance the standards of competency through provider disclosure and accurate records for healthcare workers. The goal is to guarantee transparency of the credentials for each provider working in your practice or clinic. Simple human errors have made it possible for providers to be tasked with duties that are beyond their training and experience. In some situations, physicians who have expired licenses are still able to practice. Ultimately, this can be a nightmare for professional clinics that hire multiple medical providers, as well as a threat to patient safety.
Many practice and clinic owners in the otolaryngology field are now more aware of the importance of fast and accurate credentialing and recredentialing services, having hired professional healthcare consultants to take care of outsourcing important aspects of business, including medical billing services and much more. Conducting proper credentialing of new providers brought into the practice isn’t just something that is required by payers, it is also essential to the success and reputation of the clinic itself. Risk and cost are reduced when everyone on staff has been credentialed and a diligent effort is made to conduct recredentialing services as-needed over time.
Outsourcing Credentialing and Recredentialing Services
In addition to all of the medical billing services, training and support available at MD Pro Solutions, our healthcare consultants can also assist with fast and accurate credentialing or recredentialing services, as they are needed. Outsourcing these services helps to reduce the workload on your in-house medical billing department and can expedite the results of certification for your new and existing providers. This service helps to reduce fraud and waste by centralizing the data for each provider to meet compliance requirements for insurance payers and Medicare systems.
Give us a call at 508-946-1665 to receive a FREE evaluation from our team of professional healthcare consultants. We can provide you with the tools and services you need to stay on top of your ENT medical billing services, as well as offer continued training, auditing and reviews, account management services, and much more. Make sure to ask about our fast and accurate credentialing and recredentialing services when you call MD Pro Solutions.