In order to find out precisely that how much does medical credentialing costs? You need to know activities performed under medical credentialing and that includes following.
- What are main tasks to be performed?
- How much time each task takes to be completed successfully?
- What if you don’t get it right at first place?
- What caliber of resource you will need to perform this job right at first place?
- How much it will cost you doing it in-house or outsourcing?
The main activities to be performed by credentialing expert.
- Initial setup, completion and maintenance of CAQH profile for a physician.
- Credentialing for new payers in-case new physicians are added to medical practice.
- In-Network contracting after negotiating with insurance companies in order get more what favors the medical provider or medical practice.
- Payer re-validations or re-credentialing including Medicare & Medicaid.
- Tracking document expiry for physicians such as medical license, malpractice insurance, DEA registration and others.
- Additions and deletions for joining and leaving physicians in a medical practice.
- Hospital affiliations.
- Direct deposit setups.
- Demographic updates.
- NPI registration.
- EIN Setup.
How much does medical credentialing cost?
As you are well aware of the fact that insurance credentialing is time taking process. It involves from document expiry tracking to add and remove new physician in your medical practice.
If you have 10 physicians and do it in-house with one employee. Your minimum cost will be USD 4,000 per month. If you outsource then cost can be as low as USD 2,000 per month.
Here is How?
Provider credentialing costs with one in-house employee
Let’s assume, you have ten physicians at your medical practice setup. You decide to hire one full time credentialing specialist to handle all provider credentialing activities.
The ideal candidate should have at least 5 years of experience with mid-level medical practices. USD 4,000 per month is average pay for this profile.
Moreover you may be responsible for other employee benefits as per the prevailing law in your state. Even if you assume that you will be only paying USD 4,000 per month still there can be costs such as work station maintenance, IT infrastructure etc.
Medical credentialing costs if outsourced.
In order to minimize credentialing costs and maximize the good results from credentialing, outsourcing is a trending option.
We can serve you at USD 250 per month per provider. You can get your providers credentialed with as many payers as you want. We will handle each and everything which come under medical credentialing services.
Let’s assume you have 10 physicians and no one is credentialed with any payer. You will have to pay USD 250 per month per provider for 6 months as within this time line, all of your practitioners will get credentialed with all major payers in your area.
Then you can keep us for maintenance only by paying as low as USD 150 per month per provider.
This will bring your total cost to (250*10*6)+(150*10*6)= $ 24,000 for the first year. In the second year this cost will depend on the number physicians leaving and joining your medical practice.
If the joining medical provider or doctor is already credentialed with major payers. You would just have to add it to your practice. However, if the new provider is not credentialed at all then you will have to invest more time and resources.
However its still better than hiring an employee and paying fixed costs.
How to minimize insurance credentialing costs?
You can only minimize these costs by choosing right provider credentialing company.
The best provider credentialing company should have following qualities.
- Timely follow-ups
- capable of advising best payers in your location
- capable of segment and prioritize applications
- experienced team
- Meeting deadlines
- Status reports
How much does medical credentialing cost? Final words.
You can always do it yourself but doing it right in first place is key to success. Therefore doing it wrong and learning will consume too much of your time.
Do check our ultimate guide on how to file your Medicare enrollment application.
Choosing the right physician credentialing Service Company to outsource is the best way to get most of your investment on credentialing.
If you have any question do write us at firstname.lastname@example.org