Medical credentialing is often a misunderstood process, given the complexities that it has. As such, there are different myths that have popped up regarding credentialing, and we’re here to debunk those myths with you today. Keep reading to learn about different myths that pertain to medical credentialing.
“Medical Credentialing is NOT Part of Your Revenue Cycle”
Many years back, the revenue cycle typically referred to payment gathering and claims processing. Now, the cycle has a more pronounced role, as it includes contributions that are made to revenue by medical employees, payer enrollment admins, or providers.
In modern times, the revenue cycle includes administrative and medical operations that are vital to the administration and gathering of patient service fees. The process now covers medical credentialing, primary source verification, and enrollment, among other components, which all contribute to the profits of a healthcare facility.
“You Will Be Credentialed For Life”
If a provider ends up getting into a network, it will take a lot of time and paperwork to do so. Once they’re credentialed, you’ll still have to maintain your “approved status”. This is because credentials will be constantly and carefully monitored by the companies to which the provider is credentialed.
Medical credentialing is an ongoing procedure, and you’re not going to find any one-time solutions. Providers have to re-credential with entities after certain periods of time. The exact amount of time that’s needed between each re-credentialing will vary.
“Medical Credentialing Only Takes One Application”
There have been efforts made to get payer credentialing streamlined. Some states also have mandated medical credentialing applications. With that said, many facilities have applications that serve as parts to their credentialing requirements. Credentialing is handled differently between institutions, so it’s best to check with these institutions in order to determine how best to get credentialing done.
“Credentialing Must Be Approved If I Provide My Files”
Medical credentialing can be a precise and stressful process, as there are multiple steps that need varying levels of approval. Simply providing documents isn’t sufficient, as they need to be accurate, and they need to be submitted in a timely manner. What’s also important for medical facilities is being able to follow up efficiently once the credentialing process has been finalized.
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