Can Your Hospital Afford Not to Outsource Credentialing?

As the number of satellite facilities per provider increases and the definition of healthcare expands, it adds to healthcare organizations’ burdens–not just in providing care, but also in terms of the administrative burden and costs necessary to maintain a practice. By outsourcing medical credentialing, hospitals can significantly reduce their costs.

The Cost of Inhouse Medical Credentialing

Due to the complex nature of medical credentialing, it requires coordination between several disparate departments within an organization. According to recent surveys of major metropolitan hospitals, departments that typically share the responsibility for credentialing include:

• The Compliance Office. Checks credentialing for Health Insurance Portability and Accountability Act (HIPAA) compliance.
• Human Resources. Verifies criminal background checks and education credentials.
• Medical Staffing Services. Ensures proper credentialing and privileging of the licensed medical staff.
• Occupational Health. Ensures healthcare providers are credentialed to meet the physical demands of patient care.

Added together, the time required from various staff members to perform medical credentialing is estimated to cost $6,020 per bed annually. This could total a cost of $1 million per year for a major hospital with an average of 161 beds.

Outsourcing Medical Credentialing Reduces Costs Significantly 

Naturally, it’s not an option to neglect credentialing to avoid these costs. Not only does credentialing mitigate the risk of litigation for hospitals and staff, it ensures patient safety. It’s also a requirement of federal payers like Medicare, Medicaid, and private insurance companies.

The cost of poor medical credentialing is estimated to exceed $36,000 per bed. These costs can accrue directly from credentialing neglect, such as incurring civil monetary penalties, lawsuits, and loss of federal funding, or indirectly, when theft, adverse events, malpractice litigation, and hospital-acquired infections occur. The cost of poor credentialing can quickly rise to approximately $5.8 million dollars for an average-sized hospital. In addition, there can be other indirect costs, such as rising malpractice insurance costs and associated fiscal penalties.

Although the credentialing process can be expensive and complex, your organization can reduce the time and resources it devotes to credentialing by outsourcing your medical credentialing. Instead of dedicating staff to perform credentialing in-house, an outside organization can perform these tasks for you, allowing you to commit your time, staff, and resources to provide quality patient care.

You can outsource medical credentialing by hiring an outside Credentials Verification Organization (CVO) to perform primary source verification on all your providers, so you’ll know your provider’s credentials are valid and in good standing. This can help you avoid mistakes, relieve backlogs, and speed up reimbursements.

Verisys can significantly cut your credentialing costs. If your organization is ready to save time and money on medical credentialing, reach out today.

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