Time is money may be a cliché to some, but it’s a hard truth for others—especially those in the healthcare industry. Many medical organizations are losing the battle to balance expenses and revenue.
Verifying a healthcare provider’s certifications and experience is an expensive, necessary evil. It’s a long, costly process, but a thorough credentialing procedure protects the medical organization from litigation should an employed provider commit medical malpractice. Traditionally, in-office credentialing (done by the organization’s staff) has long been a painful procedure that delays when a provider can start seeing patients and begin billing. This delay postpones revenue the hiring organization could be receiving sooner. Bills and salaries don’t wait to be paid simply because a new doctor can’t start until three months from now.
Why does credentialing cost so much? Why does it take so long to complete? Those are two critical questions, but one question outweighs them both: is there a way to obtain faster credentialing at less cost? The answer: absolutely!
Conventional Credentialing Is Slow And Costs Too Much
Let’s look at average in-office credentialing costs on a perfect day:
- Employing an in-office credentialing specialist costs a practice (on average) over $70,000 a year in salary and benefits. An experienced specialist will demand higher pay, usually over $100,000+ a year.
- Credentialing computer software costs around $400 a month (TrustRadius).
- Paperwork costs money. The average office worker uses around 10,000 sheets of copy paper per year; now, multiply that total by the number of employees on staff. This amount doesn’t include other office supplies and storage needs, which cut into revenue.
- According to MGMA research, an organization can easily spend over $7,000 on each provider’s credentialing application.
- Lastly, factor in the revenue a practice is losing because the provider isn’t seeing patients and generating revenue which can significantly impact a practice’s bottom line.
Average annual totals for provider revenue vary based on their specialties:
- A primary care physician generates around $1.5 million in revenue for their organization.
- An orthopedist generates $2.7 million.
- A cardiologist brings in $2.4 million.
- A neurosurgeon generates $2.2 million.
A medical organization won’t see this money until the provider is credentialed. Until the provider completes the process, practices can lose millions of dollars in potential revenue, and practices lose even more money when their in-office credentialing hits a snag, like clerical errors, typos, and missing forms. The staff, their credentialing skills, and work attendance significantly affect the process. Their speed and accuracy help dictate when a provider can start treating patients and generating revenue.
Conventional Credentialing Takes To Long
A standard credentialing process takes an average of 60-120 days – this is not faster credentialing! Sixty days is still too long for medical organizations to wait. They need to get paid to remain solvent, especially with the recent pressure of the pandemic. Why does the process take so long? What are some steps involved in conventional credentialing?
There are too many to list, but here are some of the core 52 conventional credentialing steps, including:
- Sending, tracking, and receiving the provider application packet.
- Obtaining the provider’s release so the credentialing agency can access the provider’s information.
- Obtaining privilege forms. Privileging authorizes a licensed or certified healthcare provider’s specific area of patient care services.
- Reviewing the disclosure’s questions and answers.
- Reviewing the explanations of employment gaps and claims history.
- Reviewing medical malpractice claims history.
- Obtaining applicable certificate copies of Board, ECFMG, Medical School, Internship, Residency, Fellowship, and two years CME.
- Obtaining copies of government-issued photo ID, DEA, and CDS.
- Obtaining CPR, ACLS, and PALS certificate copies.
- Obtaining TB, MMR, varicella, and flu vaccination records.
- Attesting any conflict of interest.
- Ordering a criminal background check.
- Obtaining an Allied Health Professional’s Supervising Physician’s Statement.
If problems arise during these steps, the process can easily stretch past the 120-day window reducing any chance of faster credentialing. Unfortunately, this delay can deprive the medical practice of revenue the provider could bring in during that time. Organizations that perform in-house credentialing are often wasting their time.
Outsourcing the job to a credentials verification organization (CVO) like 5ACVO can reduce the number of steps by 88%. They can process primary source verifications much faster than in-house methods — sometimes allowing providers to start billing one month after beginning the process. Reducing the conventional credentialing steps from 52 down to six (6) steps is smarter and faster credentialing!
5ACVO is Faster Credentialing at 69% Less Credentialing Cost
5ACVO offers healthcare providers and organizations faster credentialing and reduces credentialing costs. 5ACVO takes the traditional 52 conventional credentialing steps and reduces the process to six (6) simple steps to complete your provider credentialing process! Expediting the process from months to weeks allows providers to see patients sooner and begin billing, generating revenue for themselves and their organizations.
A few things 5ACVO can eliminate from a practice’s to-do list include:
- Initial and reappointment application distribution
- Initial and reappointment primary source verification
- Reappointment schedule maintenance
- Criminal background checks
- Maintaining compliance and ongoing monitoring
According to NAMSS, an average CVO handles credentialing 5 to 7 days faster than a medical facility. 5ACVO can get it done even quicker.
As well as streamlining the accrediting workflow, 5ACVO’s credentialing team has 385+ years of industry experience. 63% of the team has 10+ years of experience, and 44% have 20+ years of experience. On top of that, this efficient team only performs credentialing services. Their laser focus results in quicker turnarounds so that providers can see patients sooner and begin billing and generating revenue faster. In addition, 5ACVO’s sister company, Primoris Credentialing Network, can enroll providers in a health plan or network so providers can get reimbursed for services performed to patients, often with ONE application. Primoris has 54+ health plans and network options available. This incredible benefit speeds up onboarding and billing.
Here are a few real-life examples illustrating the value we can add to your organization:
- One provider completed his fellowship on July 31st. His file was finished and held until that date. The provider was verified and approved on that date, enabling them to bill on most of the health plans before his start date of August 15th.
- Another provider completed their residency before it ended on June 30th. The Fifth Avenue Healthcare Services team obtained a letter from the provider’s program director and pushed them through. As a result, they were billing on nearly all health plans as of their start date of July 1st.
- A provider moved from one group to another. We added them to the new group with all plans in one week.
- A provider was joining a medical group on March 1st. They completed their application on January 3rd. The provider was processed and approved by February 6th and began billing with all plans by that March 1st date.
5ACVO’s track record speaks for itself. 5ACVO will provide medical practices with substantial savings — 69% lower costs and 88% less work. 5ACVO also provides their clients simple access to their credentialing data. Clients will have ONE point of contact with ONE email and ONE phone number. These solutions offer superior flexibility and convenience, typically not offered anywhere else.
The benefits don’t stop with providers and their practices because patients will also reap the rewards.
A practice that saves money by outsourcing its medical credentialing can use any savings to:
- Buy better equipment.
- Hire more providers.
- Open more facilities.
These patient bonuses can decrease patient wait time and increase patient satisfaction. Patients might also be treated more effectively and efficiently when enough providers are on staff. Time is money, and conventional credentialing costs a lot of both. Smart credentialing saves both and gives both back to providers, the medical organizations that hire them, and the patients who require care.
More information about 5ACVO
5ACVO is an NCQA Credentialing Accredited specializing in credentialing and primary source verification and is part of the Fifth Avenue Healthcare Services family. 5ACVO sister companies include Fifth Avenue Agency (MPLI and medical malpractice insurance specialists) and Primoris Credentialing Network (credentialing and provider enrollment specialists with 54+ health plan and network provider enrollment options).
5ACVO originally published this article here. For more information on 5ACVO, please visit 5ACVO.com or Contact Us.
