Credentialing: When to DIY and When to Outsource


Sign Post with one sign pointing to In-House, and a second sign pointing to outsource.

Credentialing is the beginning of the process when a provider of mental health services decides that they want to take insurance on an in-network basis. Credentialing at its most basic form is a due-diligence process where insurance companies fact check who a provider says they are so they can take clients and be paid for mental health services. This process varies from insurance to insurance and can take a very long time due to the byzantine nature of insurance and the size of the insurance company that you are dealing with.


In this blog we really want to help you determine when you need to outsource your credentialing or when it would be a good idea to DIY your credentialing with insurance. As a general rule, we recommend that if you are taking insurance for the first time in your private practice career that you start slow and only take one insurance to get a sense of what the experience is like. If you are an experienced provider that is looking to fine tune your insurance paneling then we would recommend looking at our other blogs around credentialing to give you a better sense of what to do from a strategic perspective.


When should I DIY My Credentialing?

When we say “DIY” we can mean the true sense of the phrase where you would spend your time actually doing the credentialing or we can mean assigning this task to someone inside of your practice. Either way there are a few scenarios in which DIY credentialing is a good idea and can make a good deal of sense short and long term in the life of your practice.


Cost

Costing out credentialing varies from company to company, however, a typical rate of credentialing with insurance is around $250.00 per insurance panel (not insurance company). Because insurance companies offer different plans that require different applications, a company that does credentialing will quote you based on how many applications they are sending out. This can become quite expensive if you are an established practice looking to diversify your insurance offerings. If you are a new practice or a solo clinician the cost of taking on too many insurance companies can become untenable financially. It is important to count the cost of outsourcing credentialing before committing to the idea of outsourcing.


With the DIY option of credentialing, you would be doing the credentialing yourself or a member of your staff would be doing the credentialing, which can be less expensive from a cash perspective but does take time away from other duties.


Time

If you are a solo practitioner or have a small practice where you own many hats for the foreseeable future it might make sense to DIY. In some stages of private practice you have more time on your hands than other stages. If this is one of those times, then working on credentialing vs. outsourcing might make sense to fill in your time. The other benefit of doing it yourself is to familiarize yourself with how your practice runs and the details that go into the revenue generation in your practice.


However, time spent on credentialing does take away from the other elements of starting or running a practice. Like we said in the beginning of this blog, it is important that you count the cost either way when deciding to DIY or outsource credentialing


Expertise

There are some in private practice that could not begin to tell you how the backend of private practice functions. Sometimes DIY can help those people learn the backend without the expense of a consultant, but other times it can be detrimental to the life of a practice. This is where your experience and intuition would need to take over when it comes to making this decision to outsource or DIY. If you are the kind of person that doesn’t need to learn the backend and would rather outsource to someone you trust, then that would be a good decision. However, if you are the person who would like to know the intimate details of the operability of a practice, then doing it yourself would make a lot of sense.


Conclusion

Whichever route you choose to take when it comes to credentialing your practice, it is important to take into account the time, cost, and expertise that you have available to commit to this project. As always, we recommend that you start slow when credentialing with insurance so that you can gain a sense of what the process is like.


If you have any questions or concerns about credentialing or any other part of the billing process we would love to hear from you. Feel free to contact us and we will be happy to answer any and all of your questions!


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