Behavioral Healthcare Technology
DENmaar Guardian EHR/RCM Revolution

Medical Credentialing can be defined as a process of verifying whether a healthcare provider is capable of performing his duties. This often complex and long procedure involves checking the credentials of a provider such as his or her education, residency, licenses, certification, training, etc. This makes credentialing a fundamental process, which is undertaken to help medical organizations against revenue losses and patients against poor-quality healthcare.

As such, medical credentialing is integral to the success of a healthcare practice. No healthcare practice, clinic, or hospital can hope to succeed without undergoing the medical credentialing process. 

Regardless of whether you are running an established practice or are new to the game. Credentialing is something we at DENmaar recommend all medical practices take care of as soon as possible. To further convince you about the overwhelming merits of credentialing, we would like to shed light on a few facts about credentialing that every medical practitioner and enterprise should know about.

So without much further ado, let’s look at all of them.

1) Credentialing is Important to Prevent Revenue Losses

As someone running a medical practice, you must understand how important credentialing is to your enterprise’s revenue cycle. It is imperative to get credentialed if you expect to treat each and every patient that crosses the threshold of your medical practice. You have to be enrolled with insurance companies to get reimbursed for the care you provide.

It is highly recommended that new providers wait to treat patients until their credentialing process is complete. Moreover, established physicians themselves cannot treat their patients or receive payments from insurance companies for the care provided if their credentials have lapsed. They will have to wait until their credentials are again approved and verified to expect reimbursement for their services from insurance companies.

So both credentialing and re-credentialing are important to maintain the integrity of a healthcare organization’s revenue cycle. Timely credentialing ensures that a medical practitioner or practice is enjoying an optimal influx of revenue for the care they are providing.

2) Boosting Patient Confidence

As we mentioned before, the most important purpose of credentialing is to assure patients that the doctor and nurses in charge of their medical care are qualified to do their job and thus can be trusted with their care. Credentialing gives patients the peace of mind they need as they essentially put their lives into somebody else’s hands.

With credentialing, patients can rest easy knowing there was a rigorous process involved to verify the merit and experience of the healthcare provider taking care of them. The credentialing process can be a great way to identify deceitful providers and prevent them from defrauding patients.

3) Accuracy is Non-Negotiable with Documentation

Even minor errors during the documentation of your credentialing process can cost you dearly. It is extremely important to be careful when filling in important information that is mandatory for credentialing. There is an extensive amount of paperwork involved, which must all be executed accurately and in a timely manner.

Entering the wrong details, missing out on key information can delay the credentialing process for weeks. Worst case scenario, your application is rejected and you have to go through the entire credentialing process all over again. Suffice to say, this can be extremely frustrating. Hence, we recommend getting the documentation part right on your first go itself.

We also recommend having all the necessary paperwork in place as dictated by the National Committee for Quality Assurance. As such, you will have proof of due diligence and records, which can come in handy in the event of a claim’s denial or audit.

4) Follow-Up and Begin Early

Credentialing is an excruciatingly long process. The entire process can take somewhere around 90-120 days to conclude. So we recommend you start as early as possible to get credentialed in order to start inviting patients to your practice. You can hope to expedite the process by making sure all paperwork is taken care of and all details are filled incorrectly.

Make sure you follow up as frequently as possible with your verification sources. Request them to send you verification responses immediately. Follow-up throughout your credentialing process, right up until your application is approved. Do not stop until you’ve secured your enrollment.

5) Credentialing and RCM Go Hand-in-Hand

As Credentialing can help prevent revenue losses, it is only natural to draw a connection between it and a medical organization’s revenue cycle. Poor credentialing will result in delayed payments, claim denials, loss of revenue, and a number of other issues that harm an organization’s revenue cycle. In other words, credentialing helps keep the revenue cycle running, and as such, should be taken seriously.

The Bottom Line

Credentialing is extremely fundamental and no medical organization or practitioner can afford to ignore it, lest they don’t seek success in the ever-volatile and evolving healthcare industry. That being said, the credentialing process isn’t exactly child’s play. It can be time-consuming and dauntingly complex.

Most practitioners simply do not have the resources, time, or skill needed to handle the process efficiently. Fortunately, this is where we at DENmaar become so valuable. Outsourcing your healthcare credentialing burden to us will help your practice save time and money.

DENmaar is home to a team of credentialing experts who handle all the nitty-gritty details of the credentialing process at your behest, making sure you submit accurate claims and secure your enrollment with insurance companies to start treating patients.

From documentation to frequent follow-ups, we’ll take care of it all. You can contact us today to learn more about DENmaar’s medical credentialing service.

The revenue cycle is an integral part of any healthcare organization. The absence of an efficient revenue cycle management system could result in a healthcare practice losing thousands of dollars in inpatient payments, reimbursements, and other promising revenue streams. Suffice to say; a healthcare practice cannot hope to survive, let alone thrive, without a robust RCM system.

Understanding the intricacies associated with patient revenue cycle management is fundamental in handling the process efficiently. Just like any other process, RCM also consists of a few vital steps that must be followed diligently for the healthcare organization or practice to succeed. 

Revenue cycle management incorporates the entire revenue cycle, right from appointment to the eventual moment when a patient’s bill is paid in full. So without much further ado, let’s look at the essential steps required to manage revenue cycles effectively and efficiently. 

1 – Pre-Authorization/Verifying Eligibility

The very first step in RCM is registration and pre-authorization. You must gather a patient’s insurance and financial information to proceed further. This step can be improved by implementing fully integrated medical billing tools that facilitate pricing transparency and insurance verification.  

This step can be further improved by having an automated eligibility verification tool in place. The device can help save time by instantly providing insight into how the healthcare organization will be compensated for its services. The device also helps patients by reminding them of their financial responsibility. 

2 – Charge Capture

Charge capture is the second step in RCM, wherein the services rendered to a patient are transcribed into billable charges. This is the moment when a medical billing code is assigned to the claim, thus making it an essential part of claims processing. You can code more accurately by employing credible RCM software that gives you access to imperative coding tools. Accurate coding will result in timely reimbursements. You can also save tons of money on administrative costs associated with claim re-works by simply using a claims scrubbing tool to ensure each claim is coded accurately the very first time. 

3 – Claims Submission and Managing Denials

After you are done with charge capture, the very next step is submitting the claim. Accurately coded claims must be submitted to the payer to ensure timely reimbursements. It is imperative to submit clean claims to prevent claim denials. You can improve this process by employing practice management software. 

With the help of such assistance, you can track your claims in real-time. You can also stop them before they have a chance of being rejected if you believe the submitted claim has issues. Make sure the accuracy rate of your claims is as high as 99% if you seek faster compensation for your services. This can be achieved by implementing medical billing solutions that identify and notify your team of any coding errors in the claim. 

Suppose you can’t afford a practice management software or don’t know how to use it. In that case, you can outsource the RCM process to a reputable vendor who harbors the technology mentioned above and can take care of the claims submission process capably on your behalf. 

If a claim is denied, a billing partner and the right software will help you rectify and resubmit the claim as quickly as possible. 

4 – Payment

The patient’s insurance provider reviews the submitted claim. Once reviewed, the payment will be released to your healthcare organization. You can improve the payment process by implementing a billing solution that allows patients to view and pay their bills via a robust patient portal. The answer can also send scheduled reminders to patients and prompt them to clear their dues as soon as possible. The hired third-party medical billing partner can also help establish quality collection services to ensure payments are on time and complete. 

5 – Reporting

Typically the RCM process is complete once the payment has been recovered. However, it is also essential to have access to quality reports that give insight into the entire revenue cycle management system. These insights can devise strategies to avoid mistakes associated with the RCM process in the future. The reports will help you find out the areas that need improvement in how RCM was performed to ensure you are not losing money. Your billing partner can help you reduce time in A/R by identifying roadblocks in the revenue cycle with comprehensive reporting.  

Outsourcing to DENmaar for Hassle-Free Patient Revenue Cycle Management. 

It is also important to note that managing a revenue cycle can be tedious and time-consuming. Spending hours sifting through patient data can be frustrating for staff members who are also responsible for other healthcare organization or hospital administrative tasks. An overburdened staff can commit errors that ultimately affect the overall quality of an RCM process. 

As such, a fundamental step in revenue cycle management also involves the question of RCM outsourcing. A healthcare organization must decide whether they want to outsource RCM services or take care of them in-house. In hindsight, outsourcing RCM to a reputable medical billing company has proven to be a cost-effective and time-efficient practice that has immensely benefited many practitioners, hospitals, and healthcare organizations. 

Outsourcing is a wise practice to consider if healthcare organizations seek to maximize their profits and drastically reduce the burden of patient revenue cycle management. DENmaar is one such medical billing company with an impeccable reputation when it comes to the rendering of quality RCM services. 

We at DENmaar are insurance billing experts. Together with our robust RCM software makes DENmaar more than capable of not only managing your entire revenue cycle efficiently but also helping your organization succeed with a fully optimized medical billing system. Get in touch with us now to know how DENmaar can help you with your medical billing processes. 

Medical credentialing has to be the single most important thing that every healthcare practice and practitioner needs to undertake in the United States. It is a process by which the expertise and qualifications of doctors and nurses are verified. As such, this is one procedure that helps patients trust the healthcare provider of their choice.

Simply verifying a healthcare organization of a practitioner’s credentials isn’t where the merits of the medical credentialing end, though. There is an important financial incentive involved in getting credentialed as well. For instance, most healthcare organizations cannot receive payment for the care offered from insurance companies like Medicare and Medicaid if they do not have medical credentialing.

That being said, we’ve barely scratched the surface trying to explain how fundamental a role medical credentialing plays in the success of healthcare professionals and organizations. There is way more to unpack with medical credentialing when it comes to its benefits. That is what we will try to accomplish today with the help of this article.

We will be looking at all reasons why medical credentialing is vital for hospitals, clinics, and healthcare professionals in general.

But first… let’s take a brief detour to understand how ancient this ostensibly modern practice is.

History of Medical Credentialing

Medical credentialing isn’t a new concept. Instead, it is somewhat of a tradition that has lasted for centuries in a variety of forms. Its origins can be traced all the way back to 1000 BC. The first-ever medical credentialing process took place in ancient Persia, where the cult of Zoroaster demanded a physician treat three heretics.  If all three survived their treatment, the physician would be qualified to provide care to patients until the end of their life.

We’ve come a long way since then. The process has evolved to become much more regulated. However, the basic gist of the procedure remains the same – to ensure that a doctor or nurse is qualified to administer treatment to patients.

  Reasons Why Credentialing is Important

1. Protecting Patients

As we mentioned, medical credentialing is undertaken to determine whether a practice or healthcare professional is qualified to treat patients. Patient care has always been the core purpose of medical credentialing. The process itself is rather complex and involves verifying a practitioner’s credentials against various relevant data points.

For instance, a practitioner is continuously checked against major publications like Death Master File, Sex Offender Registries, National Abuse Registry, OFAC, and many other sources. A provider can be denied credentialing if their name shows up in any of the above data points. Credentialing can also be denied if a provider’s license has expired or defaulted on their student loans.

Credentialing instills confidence among patients. For example, it would be nice to know that a particular doctor in charge of providing treatment to a child is not a registered sex offender or that a psychologist has the qualifications necessary to provide you with sound advice.

Competency and Performance Reviews are an integral part of the credentialing process. Organizations in charge of this process leave no stone unturned in determining whether a practice or healthcare professionals are worthy of being credentialed. As a result, patients can feel safe going for treatment to clinics and hospitals whose staff are all credentialed.

2. Helps Medical Organizations Prevent Revenue Loss

It is important to note that no insurance company will reimburse a hospital or medical practice if they lack medical credentialing. A medical organization has to first get in-network with insurance carriers like Medicare, Medicaid, etc., to be able to cater to patients with health insurance. A non-credentialed medical organization is not complying with state and federal regulations. This alone can open a can of legal issues (more on this later.)

To put it more succinctly, an insurance carrier will deny reimbursement to a healthcare organization if they hire providers that aren’t credentialed. Furthermore, if a refund has already occurred and it is later revealed that the provider did not possess medical credentialing, they will be hit with fines and civil monetary penalties. Therefore, a healthcare organization must make sure a provider’s credentials are verified upon hire. Not doing so only leaves the practice open to a severe financial hit down the line.

Read More: 5 Things to Learn about Medical Credentialing Process

3. Medical Credentialing Helps Providers Avoid Lawsuits

In a lawsuit, Medical Credentialing has proven to serve as a cover protecting healthcare organizations. For instance, the first thing the law will consider when examining a lawsuit against a healthcare practice is whether or not it complies with state and federal regulations. If a medical practice follows best practices and possesses staff with the necessary accreditations and qualifications, the organization is more likely to imprint a good impression on the Justice System.

On the other hand, if a healthcare organization faces medical negligence and patient endangerment charges, its providers are excluded from medical credentialing. As a result, there is no way to win a lawsuit. Moreover, losing the lawsuit won’t be the worst thing that happens to the practice. The organization’s reputation will be destroyed in the media, leading to serious patient mistrust.

  The Bottom Line

Medical credentialing does a lot more than just verifying healthcare professionals’ legitimacy as you learn for yourself. Medical credentialing is such an integral part of our healthcare system today that no healthcare practice can thrive, let alone survive, without undertaking the process.

That being said, the credentialing process isn’t exactly child’s play. It can be complex, time-consuming, and overwhelming to undertake. Fortunately, we at DENmaar take care of the often excruciating credentialing process. Our credentialing specialists ensure you have error-free paperwork ready to help you get in-network with insurance carriers as quickly as possible.

Over the years, we’ve helped many healthcare organizations with their credentialing tasks, thus providing them with more leeway to focus on patient care and other core areas of their practice.

Contact DENmaar now to learn more about the medical credentialing process and how we can help your practice.