Ever wonder what makes a healthcare organization successful? Let me tell you – the medical credentialing company offers billing services and takes charge of the whole organization to make it flourish. It does not only benefit the healthcare providers but also the payers and the patients for safe and easy access to healthcare while resulting in the success of medical practices.
Medical Credentialing Company: An Overview
A medical credentialing company assists the healthcare organization in credentialing, which includes the systematic verification of the qualifications of healthcare practitioners, ensuring professional integrity.
Services by a credentialing company
Following are the four services that a credentialing company provides
- Inclusive credentialing services.
A credentialing company provides comprehensive services that range from verification of academic qualifications to thorough investigation of the licenses and certifications the professionals hold.
- Payor enrollment
A credentialing company assists practitioners in participating in insurance networks like Medicare, Medicaid, and the like.
- Database management
Similarly, a credentialing company helps healthcare practitioners maintain accurate, precise, and up-to-date information for transparency and trust building.
- Updating the credentials
Last but not least, these companies regularly update their credentials to maintain the quality of healthcare delivery.
Step-by-step process of credentialing
Since we know the services a credentialing company provides, now it’s time to know how the process takes place. Following are the general steps that a company follows for verification.
- Data compilation
The first step is to gather all the important data required about the provider, including personal information, academic details, previous work history, etc.
- Completing the application process
The second step is to complete all the payer-specific applications and record all the provider’s information in the company’s system for easy access.
- Verification of all the documents
The third step is to verify all the documents that are collected in the first step.
- Credential inquiry
The fourth step is to assess the competence of the applicants to meet the established criteria by the payers. This step is followed by an evaluation of practitioners’ previous work history and experience.
- Application Submission
This is the final in which the applications are submitted.
- Regular follow-ups of the application
In this process, the company carries out regular follow-ups to solve any potential issues while informing the providers about their application’s status.
- Completion of credentialing
In this step, the company informs the provider about the application’s successful completion and provides further necessary information.
- The process of re-credentialing
In this step, the company tracks the expiration of all the academic records submitted by the providers and prepares for the process of re-credentialing.
How to know if a credentialing company is competent?
Following are the four key elements to consider about Credential Company’s competency
- Such companies always have a thorough knowledge of credentialing standards set by the regulatory authorities
- They are knowledgeable about document management.
- They have strong communication skills for an effective and smooth credentialing process.
- They stay up-to-date about technology usage for error-free credentialing of the documents.
Importance of a medical credentialing company
The role of a credentialing company is very important for all – the patients, the healthcare providers, and the payers in terms of professional, economic, and safety aspects.
- Professional aspect
The credentialing company proves to be time-saving, considering the time-consuming characteristic of the credentialing process. It reduces the overall waiting time of the patients; hence, optimizing the overall efficiency of the healthcare operations.
- Economical aspect
In this aspect, credentialing companies ensure that the payments are instantly approved to guarantee maximum profitability and improved revenue generation.
- Security aspect
The credentialing process reduces the risk of fraudulent claims and minimizes credentialing errors while improving patient’s safety and access to care. Moreover, they stay up-to-date with the dynamic regulations to meet the relevant standards.
Since we know the details about the medical credentialing company, the question arises, how does a company manage all these tasks? Do they have any staff? Or everything is computerized? Well, the answer is, they have certified medical billers!
Who is a certified medical biller? And what are his roles?
It is a person who is skilled and certified in medical billing is called a certified medical biller, and all the billing duties are entrusted to him. Its duties include but are not limited to
- Assigning appropriate medical codes to patients’ diagnosis of their ailment and its treatment procedure.
- Preparing and submitting insurance claims to the insurance payers.
- Religiously tracking the claims, resolving the denials, and appealing to rejected claims.
- Transferring payments to patients’ accounts.
- Carefully preparing and sending patients’ bills.
- Involvement in patients, communication, and staff training.
Conclusion: Importance of a Medical Biller
Now that you know the role of a medical biller, you must know that it plays a very important role in terms of financial, compliance, and patient satisfaction aspects. It is one of those important aspects for the smooth and error-free operation of healthcare administrative tasks.
Now, put your trust in our certified, well-qualified, and dedicated team to ensure a smooth credentialing process. Join us!
