Anesthesia Coding Alert

Practice Management:

Consider This Advice When Credentialing New Providers

Published on Tue Jan 11, 2022

Ask yourself whether keeping the work in-house is worth it.

One important aspect of adding new providers to your practice is credentialing. And while many practices handle the process themselves, others determine that outsourcing the work to a dedicated service better serves their group’s interests.

“I think there are a lot of variables here that impact whether it’s a good business decision,” says Christine M. Speroni, CPC, an administrative office manager for a practice in Ronkonkoma, New York.

As you move into the New Year, it could be time to evaluate whether your current process for credentialing is still your best tactic. Speroni offers several tips to keep in mind as you make the decision.

Be Mindful of These Variables

To figure out whether you or a team member should put forth the effort to credential, you need to look at the scope of the effort. Maybe the biggest thing to keep in mind is evaluating whether focusing on credentialing will take you away from other work responsibilities and whether your practice can bear that redirection of focus.

When you’re considering whether to credential in-house or to outsource, start with the numbers: how many providers and the frequency of provider turnover.

“In a small office with steady providers, I don’t think an outside service is worth it,” Speroni says. “If you are a larger group, or [have] frequent provider changes, then I would debate between in-house dedicated staff and an outside company.”

It’s the same type of decision as using an outside or in-house billing service, she says.

In a small practice, it may be worth putting other work on hold for the time it takes to credential a couple of providers. In a larger practice or organization, the workflow and workload may just feel impossible.

Ultimately, you need to determine any credentialing obstacles and decide whether outsourcing would even alleviate those issues, Speroni says.

If you don’t feel like you have the bandwidth — whether that’s time, energy, knowledge, or some other reason — to perform the credentialing yourself, shop around with the outsourcing. Before going with an outside company, it’s important to gauge their responsiveness and understand their fees.

Be Attuned to Detail

You know that nailing the nitty-gritty specifics plays a large role in successfully completing the credentialing process, so it’s important to take that into consideration.

Do your homework ahead of time, and make sure your research is thorough.

“Just like with an outside billing company, you are giving up some level of control when they are not your employees,” Speroni notes.

Consider accountability, too, because the financial impact of any mistakes can be significant. If you are confident that you will feel less anxious if you personally perform the credentialing process, take that into account when making your decision.

“Any mistake can have significant financial impact. If this outside company are experts, they may make fewer errors than you would. If this outside company doesn’t pay attention to details, they may make more errors than you would,” Speroni says.

Steer Clear of Salesmanship

Objective, unbiased research about the expense and time necessary for the credentialing process is hard to find.

Credentialing companies probably offer information, but it may not accurately portray the cost to benefit ratio.

“My guess is the only statistics you will find will be from the credentialing companies themselves trying to sell their services, which I suspect could be biased toward the benefits only,” Speroni cautions.

Ultimately, you know your practice’s situation best, as well as your own propensity for managing “extra” work and your attention to detail.

Thinking through all of the variables, including the potential financial savings versus costs — particularly with any errors — is crucial when making the decision about whether to DIY or outsource provider credentialing.