Exploring the Risks and Rewards of Delegated Credentialing

In the current healthcare landscape, medical credentialing plays a major role in confirming the competency of healthcare providers. However, for many healthcare organizations, managing this process in-house can be a complex and time-consuming task.

This is where delegated credentialing comes in. By outsourcing this responsibility to a specialized third-party organization, such as a Credentials Verification Organization (CVO), your organization can save time and money while achieving the desired goals.

Let’s take a closer look at the risks and rewards of delegated medical credentialing for your organization. Weighing these pros and cons can help you make an informed decision about the outsourcing process.

What is Delegated Medical Credentialing?

Delegated medical credentialing is the practice of outsourcing the credentialing process to an external entity. This involves the verification of the healthcare provider’s credentials to ensure compliance with the goal to receive compensation from insurance companies.

To complete credentialing, the CVO performs comprehensive evaluations of healthcare provider’s:

·        Licenses

·        Certifications

·        Education

·        Training

·        Work history

·        Malpractice history

They verify the validity of the information tendered by the providers to make sure that it’s sufficient to allow enrollment.

By delegating the credentialing process to a CVO, healthcare organizations can benefit from their expertise, resources, and established relationships with various entities. This contributes to a more streamlined and efficient credentialing process while reducing the administrative burden and enabling healthcare organizations to focus on delivering quality patient care.

Benefits of Delegated Medical Credentialing

Delegated credentialing is particularly beneficial for healthcare organizations that may lack the expertise or time to handle the complex and time-consuming credentialing process in-house.

By outsourcing this task, healthcare organizations don’t just take a major burden off the internal staff’s shoulders. They speed up the process and take a big step toward increasing patient satisfaction.

Reduced Costs

Outsourcing credentialing can significantly reduce staffing costs associated with maintaining an in-house credentialing team. By partnering with a CVO, healthcare organizations can leverage their expertise and resources and eliminate the need for extensive internal staff and infrastructure.

With the base salary of a credentialing specialist being around $40,00 a year, these savings can be substantial.

Higher Provider Satisfaction Rates

Delegated credentialing can lead to higher provider satisfaction rates. CVOs specialize in this process to ensure a smooth, stress-free experience for providers.

With a dedicated team handling the credentialing procedure, providers can focus on patient care instead of worrying for months about the credentialing outcome.

Healthcare providers who benefit from a smooth enrollment and re-credentialing process are more likely to stay with the organization.

Faster Credentialing Process

One of the key advantages of delegated credentialing is the time you can save on the process. By leveraging their experience and established relationships with various organizations, third-party service providers can achieve quicker enrollment.

Without professionals at the helm, the credentialing process can take more than eight months. During this time, your patient satisfaction rates could plummet. Meanwhile, the healthcare provider is likely to be extremely frustrated.  

Reduced Management Burden

Managing the credentialing process internally can be time-consuming and resource-intensive. Delegating this responsibility frees up administrative staff and allows them to focus on other revenue-generating tasks.

Improved Accuracy

Service providers that specialize in credentialing and have rigorous processes in place to ensure accuracy and compliance. By leveraging this expertise, healthcare organizations can benefit from improved data accuracy. This reduces the risk of errors and prevents potential compliance issues.

Enhanced Enrollment Process

Delegated credentialing providers have access to best practices and benchmarking data. CVOs continuously evaluate and improve the enrollment processes and make sure that their clients stay updated with the latest standards and regulations.

Disadvantages of Delegated Medical Credentialing

While delegating medical credentialing has many impressive benefits, it comes with a few risks. If you evaluate these risks in advance, you can save time and money while reaping the top benefits of the outsourcing process.

Reduced Control Over the Credentialing Procedure

Outsourcing credentialing means relinquishing part of the control over the process. While CVOs follow established protocols, healthcare organizations may have limited influence on specific aspects of the credentialing process.

While this results in less flexibility, third-party credentialing providers don’t have full control of the procedure. The decision about enrollment is still made by the organization.

Time Spent on Choosing the Right Vendor

Selecting a reputable and reliable CVO requires careful consideration and research. Healthcare organizations need to invest time in evaluating potential vendors, their track record, and their ability to align with specific organizational needs.

However, working with a credentialing organization has a high return on investment (ROI). Each hour you spend choosing the vendor is an investment in a streamlined credentialing process.

Possibility of Miscommunication

Communication is a big part of the credentialing process. The involvement of a third party introduces the possibility of miscommunication. Clear and effective communication channels must be established to avoid errors or delays. Before signing a contract with the service provider, make sure to discuss its communication methods.

Leveraging the Benefits of Medical Credentialing

Delegated credentialing comes with numerous advantages for healthcare organizations, including reduced costs, higher provider satisfaction rates, and access to industry expertise. While there are potential disadvantages, the benefits usually outweigh the risks.

By choosing a reputable and reliable CVO and establishing effective communication channels, healthcare organizations can leverage their expertise to streamline the credentialing processes.