How Does Healthcare Credentialing Affect Revenue Cycle Management?

How Does Healthcare Credentialing Affect Revenue Cycle Management?

Healthcare credentialing is an essential process in the medical industry that ensures a specific provider is trained and able to provide medical care. However, healthcare credentialing is often lengthy and complicated, so most practices seek help from professional consultants to speed up the process.

In addition, healthcare credentialing is vital for revenue cycle management because it allows you to receive reimbursement from insurance companies. Read on to learn more about credentialing, revenue cycle management, and how to find the necessary help to improve those aspects.

What Is Healthcare Credentialing?

Healthcare credentialing refers to the process of confirming the education, training, and competency of medical workers. Authorizing entities verify this information to prove that a medical practitioner is capable of delivering patient care. That ensures a high level of care throughout the medical industry.

You need to get credentialed to receive reimbursements from Medicare, Medicaid, and insurance companies. So, this process is vital for the financial well-being of your practice.

What Is Revenue Cycle Management?

Revenue cycle management (RCM) refers to the process of collecting revenue by medical practices. It begins when a patient makes an initial contact with your practice, and includes every little step until they settle the final balance. Good RCM is necessary to keep the income flowing and ensure financial viability.

One of the most critical things in revenue cycle management is submitting claims to insurance companies and collecting them. This accounts for the majority of profits and is vital for all healthcare entities. 

How is Practice Revenue Related to Healthcare Credentialing?

Healthcare credentialing is often an overlooked factor in your revenue cycle management. However, it can lead to loss of funds, compliance issues, impaired team morale, and other issues.

Credentialing a new healthcare provider can be very time-consuming. A typical process takes several months but can sometimes take up to one year. During that time, a physician cannot receive reimbursement,which  significantly impacts a medical practice’s financial potential.

Lack of credentialing contributes to denied claims as medical practices report a lack of communication from payers, new insurance plan issues, changing requirements, long processing delays, and other problems.

These denials lead to a drop in key performance indicators (KPIs) in the revenue cycle management, such as clean claim rate, aging claims, and days in A/R. These KPIs are essential for financial well-being, and a sudden drop can hurt your practice.

Hiring an Outside Consultant Can Speed Up Healthcare Credentialing

The problem with healthcare credentialing is that it is increasingly long and complex. The longer the process drags on, the more revenue you lose. So, going through healthcare credentialing more quickly is the goal.

Working with an outside consultant like Peregrine Healthcare can significantly reduce the time needed to complete the credentialing process. We are knowledgeable about requirements and possible shortcuts, so we ensure that all paperwork is submitted on time. That way, you’ll become credentialed as quickly as possible, boosting your income flow.

In addition, we can help you boost your key performance indicators and improve your revenue cycle management. Schedule a consultation with us by calling 877-463-1110 or visiting our contact us page.