How Medical Credentialing Services Benefit Physicians

Almost no one with medical insurance is going to go to a doctor that does not accept it, because the price of medical care is too expensive for most people to pay for out of pocket.In fact, when someone is searching for a health care provider, the first thing he or she usually does is enquire whether the provider accepts his or her insurance. However, staying current with insurance plans is not easy for doctors. Doctors go to medical school to learn about caring for people through medicine, not about filling out paperwork

What Is Medical Credentialing?

Medical credentialing is the term used for determining whether or not a medical provider is qualified to participate with a given insurance company. The policies of various insurers differ and each has its own types of applications and guidelines to follow. If the provider is considered to have the appropriate credentials and qualifications then the insurance will agree to pay for his services to their enrolled patients.

Why Physicians Must Participate

Only accepting one or two types of insurance, or not accepting insurance at all, is within the realm of possible business models; it is not an extremely lucrative one, however. The truth is that the more insurance providers a physician is accepted by, the more patients he can potentially treat. He also will have a back-up plan in the case that he is suddenly dropped from one or more companies or that the companies go out of business.

The Paperwork Challenge

While most physicians understand why they need to be credentialed by as many insurance plans as possible, doing so is not always a simple matter. Sometimes the amount of paperwork required for each company is extremely large and time-consuming to fill out. Doctors are well-known for working long hours and going without sleep to meet the demands of their patients. The added responsibility of filling out copious amounts of forms is often too much for their schedules to allow and they simply cannot get it done.

Medical Credentialists Are Paperwork Experts

Fortunately for doctors, no medical practice is run as a one-man-show.Besides nurses, usually on staff is an office manager.His or her job is to oversee appointments, billing, ordering of medical supplies and other tasks necessary to the functioning of a medical clinic. Like the doctor, this staff member is often extremely busy, too, and does not have time for the added responsibility of dealing with insurance companies. Thus many practices employ outside medical credentialing services to fill this role. These professionals specialize in the service they provide, and handle all aspects of the credentialing duties. Although independent, they act just like a part of the office staff whose job is to relieve the doctor and the office manager from the burden of paperwork.

Forms necessary to be accepted by insurance companies can be difficult to complete. By employing medical credentialing services, doctors can focus on the things they do best, and leave the paperwork to someone else who specializes in this type of task.