In recent years, credentialing has become much more important in any dermatology practice as insurance coverage is a priority for many people. Just a few years ago, that wasn’t the case, and people were more likely to pay out of pocket or see an out-of-network provider for medical dermatology services. As times and expectations change, it can be an onerous task for a medical practice to add in new policies and services. Yet, for practices that want to remain current and provide professional services, credentialing is no longer optional.

Credentialing in Context

As more and more people have healthcare coverage and are seeking to receive medical treatments through their insurance provider, the long, arduous cycle of credentialing can cost heavily in administration expenses and time for dermatology practices. Choosing not to get on insurance panels will cost you patients; and perhaps to some degree your professional reputation.

To further complicate matters, the requirements for licensing and credentialing differ from state to state, and by provider type and speciality. For overwhelmed practices, there is an option. Having an organization you trust handling your licensing and credentialing will ensure all requirements are met for every provider and location of your practice.

The Top Three Real Advantages for In-Network Providers

Although it can be tedious, there are quite a few benefits of becoming a participating provider with insurance networks that make the commitment well worth it:

  • Increase in potential clients via network partners
  • Quick and efficient billing and payment with fewer complications
  • Indirect marketing, networking and advertising opportunities

The process of credentialing involves getting approved by individual health plans. Approval can take up to six months with specific forms, applications, processes, and rules that must be adhered to. Outsourcing credentialing will not only save you time, it also ensures timeliness and accuracy.

Agencies experienced with credentialing will complete everything required on behalf of your practice. Finding and building a relationship with an organization through which you can outsource administrative duties will provide a source of on-going support.

What Can Be Outsourced

The following steps can be outsourced for mutual success:

Step 1: Manage Fee Schedule. Maintaining proper paperwork including time-sensitive documents, contracts with health insurance plans, and reviewing contracts and verifying information are all important parts of the process that require attention to detail.

Step 2: List All Locations. All locations where patients are receiving treatment must be included in order to ensure compliance. Then, if any new locations are added, they must be updated with insurers before any claims can be made. These particulars can be managed and reviewed on an on-going basis.

Step 3: Denial Review. Standard procedure usually has denials of claims reviewed on a case-by-case basis, which can be beneficial in ascertaining the circumstances. At the same time, it is important not to overlook the cumulative problems in order to prevent or avoid specific issues that may be causing the denial in the first place. In this way, the system will become streamlined.

Step 4: Addressing Errors. The implementation of National Provider Identification (NPIs) numbers was intended to streamline the claims process for individuals and groups. The goal was to make claim approval and payment less time consuming and less complicated. At the same time, there are now more stringent guidelines to follow, and errors in submissions do occur.

Through all of the steps, as well as any time a service is outsourced, you and your staff can focus 100 percent on your patients and your practice instead of getting caught up in the minutiae that can have you running around in circles. More and more practices are choosing to hire experts to handle these services, instead of having to become an expert on the precise protocols. It can become a full-time job, managing the many different agencies and requirements, including:

  • Medicare/Medicaid
  • Commercial Payors
  • Practice Set Up (NPI, CLIA, DOH Radiology)
  • Lab Partnerships
  • Mohs Set Up
  • Hospital Privileging
  • Provider Licensing
  • DEA Licensing
  • DME Credentialing
  • CDS Licensing
  • CAQH Profile Maintenance
  • Expirables Management

Having someone else handle the administration of your credentialing and licensing and paperwork for each individual requirement will serve your practice well.

Benefits of Outsourcing Are Far Reaching

Finding a professional agency to handle this imperative aspect of your practice is a great way to remain focused on current patient needs. These include:

Reduced operating costs. It might be surprising to some but outsourcing these services can actually save you money, as the agency will complete the requirements in a more timely and efficient manner.

Receive expert services.: Outsourcing is the epitome of working smart not hard. Working with an organization that specializes in the work required for credentialing and licensing, ensures your practice is running smoothly. That way you can do what you do best and outsource the rest to the people who do those things best.

Expand your resources. By outsourcing specific services you will build a working relationship with a number of people and organizations that can offer additional benefits to your practice.

Ensure accuracy. Having a contract in place to manage your credentialing and other services will ensure no details are forgotten. Outsourcing reduces errors and optimizes billing and collections.

Whatever the reason you decide to outsource, choose a company that has experience and that works with all payor groups. Also ensure that they have the knowledge of multiple locations specifically in your area.

Kim Campbell is the Founder CEO of Dermatology Authority, which is the leading matchmaking agency for the dermatology market.

Dermatology Authority helps practices grow by adding providers, practices, marketing, and practice start up services. If you are looking to advance your career, Ms. Campbell can be reached at or 800-577-0125.