Medical payer credentialing is the business process by which hospitals, insurance networks, and healthcare organizations assess and confirm the credentials, qualifications, and experience of a healthcare provider or professional. The process is imperative for both the doctor and the patient as it ensures that the medical practitioners are qualified enough to do so.
Credentialing is a critical business process within a hospital, physician’s clinic, and medical industry. It is a very important step both for the doctor, as well as, the patient.
Let’s find out why medical payer credentialing so important:
Strong trust between the patients and medical professionals is a prerequisite in the health care system. If there is trust among the patient and the doctor, then the patient will be able to open up with the doctor and disclose information without any hesitation in the perception of better care and recommended treatment.
Patients who are not well aware of the qualifications and experience of their doctors are likely to put less trust in their doctor. Getting the qualification of the healthcare providers and hospitals assessed and confirmed assures the patients of the merit, as well as, the experience of the doctors, thus instilling a sense of greater trust in the abilities of the doctors.
2. Prevents hospitals and healthcare providers to lose their revenue- For any healthcare provider or hospital, it is extremely necessary to partner with experienced insurance companies. Most of the time healthcare professionals and physicians are expected to go through the process of verification by the insurance companies if they want to get their reimbursement expenses.
Failure to get proper medical credentialing by the healthcare providers can result in insurance companies not reimbursing the medical bills and clearances of the providers. However, there is a timeframe within which the healthcare professionals have to file with the insurance company for the reimbursement of the medical expenses. The medical practitioners can risk losing thousands of dollars which might not get recovered from the insurance payer.
3. The risk of medical errors is lowered to a great extent– studies have proven that many patients die every year due to major medical errors committed by the hospitals. This worrying situation compels the healthcare providers to improve their standards of competency and expose their healthcare workers to strict disciplinary actions.
Obtaining the credentialing by the healthcare providers, more so independent medical providers, helps in reducing the greater risk of medical errors that might be committed by the incompetent healthcare providers. Furthermore, all the credentialing is done electronically which employs automation tools, so no room is left for the human error or fatigue which might have been associated with manual evaluations by the hospitals and clinics.
4. The reputation of the payer is drastically improved- With more and more patients researching in detail before getting the services of a healthcare provider, it is becoming vital for the practitioners to manage and control their reputation to retain their clients. Medical payer credentialing is a crucial step that could be taken by medical practitioners to improve their reputation in the healthcare industry.
A medical professional who has undergone the process of credentialing is allowed to treat all the patients freely irrespective of the insurance plans. In this way, the professional will be handling a diverse range of patients and earning great expertise and reputation as per the industry standards.
5. Medical payer credentialing helps in improving the business of the medical practitioner as well as the payer- Proper credentialing ensures that the medical practitioner will be able to accept patients who are possessing health insurance plans. Most of the clients are carrying health insurance plans. Thus, the doctor can boost an increased client base and get more customers.
If the doctor is getting more customers, certainly more and more people will get their health insurance plans done.
Also, most of the patients look forward to meeting the same doctor repeatedly. This is because they have developed trust and confidence in their treatment process. Physician credentialing will, therefore, will lead to recurring patients which, in turn, improves the business of the healthcare provider, as well as, the insurance company.