Medical Credentialing is Important for Building a Successful Practice

by | Mar 11, 2015 | Medical Billing, Medical Credentialing

Medical credentialing is the process of ensuring that healthcare organizations are in compliance with certain regulations. In most cases, this means communicating with insurance providers so that medical providers are able to accept third-party reimbursement for their services. Credential services specialists work closely with hospitals, physician offices and ambulatory care facilities in addition to insurance companies and credential verification organizations.

Some healthcare professionals see credentialing services as unnecessary or even a hindrance to their day-to-day operations, but the truth is that they are more important to the healthcare industry than ever before.

The Importance of Insurance

There was a time not too long ago when credentialing service specialists were considered optional to medical practices. Some patients would use their health insurance to cover treatments and procedures, but there were also plenty of people who were willing to pay out of pocket. That time is long gone. Presently, the vast majority of Americans have health insurance, and they are far more likely to use it than in the past. This is also due to the broader scope of many of today’s health insurance plans, which cover a wider range of treatments and procedures than before. Insurance plans cover more mental health and behavioral health treatments, there are fewer restrictions when it comes to pre-existing conditions, and even supplemental services such as physical therapy and holistic healing services are now covered.

Unfortunately, the changes that have been made to health insurance coverage over the last few years has also made credentialing services more complicated. While many healthcare facilities could perform these duties themselves before, hiring a credentialing specialist or doing business with a credentialing service is essential today. The right credentialing service can ensure that your medical practice is always in compliance with billing regulations and they can act as mediators between yourself and insurance companies. This can save you a lot of time and energy that would be better spent providing services to patients.

Making Your Job Easier

More than anything else, a medical credentialing specialist will give you peace of mind. Insurance is an increasingly large aspect of operating healthcare services, but it is far from the most important. Your staff needs to be able to provide services to your patients, and they shouldn’t have to feel like they’re spread too thin if they have to solve an insurance issue. Hiring the services of a credentialing specialist helps make your job easier, even as medical insurance becomes more complicated.


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