Payer Credentialing Cost.
To manage it in economic way. You need to understand the activities that consumes credentialing costs. Building the understanding will enable you to make the best decision regarding effective and efficient management of payer credentialing costs.
Lets figure out, what activities fall under provider credentialing services?
Main activities performed in payer credentialing.
Knowing this is super important. Identifying activities performed under payer credentialing will help you understand 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 for credentialing specialist are as follows.
- Initial setup, completion and maintenance of CAQH profile for a physician.
- Payer credentialing for new payers in-case new physicians are added to medical practice.
- In-Network contracting after negotiating with payer 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.
- Demographic updates.
- EIN Setup.
How much does payer credentialing cost?
As you are well aware of the fact that insurance payer 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?
Payer credentialing costs with one in-house employee
Lets assume, you have ten physicians at your medical practice setup. You decide to hire one full time payer 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 payer credentialing costs and maximize the good results from credentialing, outsourcing is a trending option.
You can hire credentialing company at USD 250 per month per provider. You can get your providers credentialed with as many payers as your want.
The medical payer credentialing company will handle each and everything which come under medical credentialing services.
Lets 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 the payer credentialing company 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
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 medical insurance credentialing company and outsourcing is the best way to get best return of your investment on credentialing.
If you have any question do write us at email@example.com