Medical Billing, Credentialing Corner

# 2025 Best Practices for Medical Billing and Credentialing Services

- January 13, 2025
- Posted by Kristen Edwards

15 May

The process of submitting and following up on the medical claims for the services provided by healthcare providers is called medical billing. The process involves multiple steps and factors to consider when they must be submitted accurately. Medical billing and credentialing are also critical in healthcare as they assist healthcare providers in getting complete reimbursements for their services.

Through medical billing, it gets ensured that the healthcare providers will be paid for their services. This can be acquired when the bills are timely and accurately processed, so there will be no delays in the reimbursements of medical claims. In addition, timely and regular medical billing ensures that the revenue is consistent and practice is maintained.

Keep reading to learn what is credentialing and medical billing help providers and healthcare practice members manage their revenue cycle.

## Importance of Medical Billing for Healthcare

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Hospitals and medical organizations in the healthcare industry often utilize medical billing software, which eventually becomes one of the integral parts of the medical billing system. Here’s how medical billing software expedites the process while making sure that all the requirements are met.

### Improved efficiency:

Medical billing software systematizes a range of tasks, both administrative and organizational tasks. One of the major tasks associated with billing is compiling, submitting, and following medical claims. With this, medical practitioners improve their proficiency, productivity, and efficiency. Hence, allowing them to dedicate more time to patient care.

### Better patient experience:

Billing for medical services can streamline the billing process, resulting in a better patient experience. In this way, patients can concentrate on their health and well-being without worrying about their treatment’s financial aspects.

Medical billing plays a crucial role in the medical industry by assisting healthcare providers in receiving timely and accurate payments. In the end, this supports the provision of high-quality healthcare and benefits patients and healthcare providers.

## What is Credentialing?

Credentialing is an important part of medical billing. In this process, physicians’ credentials are verified, and their eligibility to provide quality health care is confirmed. Both medical billing and credentialing can contribute to improving the overall quality of healthcare.

Medical credentials are essential for employment in a high-risk industry such as this. Patients can feel confident that their healthcare provider is certified, licensed, and current with their credentials. Professionals in health care can benefit from credentialing in several ways.

There are no modern inventions when it comes to physician credentialing. This concept dates back to 1000 BC and the Zoroasters, a religious group in Ancient Persia. A law book called The Vendidad outlined three heretics that medical practitioners needed to treat. Medical practitioners are allowed to practice medicine legally if all three patients survive. They would be banned from the medical profession for life if all three patients died. But what is credentialing? In the modern era?

Despite the evolution of credentialing since ancient times, its importance has remained the same. Medical data on each person seeking medical credentials is gathered and reviewed by the National Practitioner Data Bank. This study examines several factors, including:

- Training
- Education
- Residency
- Licenses
- Qualifications
- Work History
- Certificates

## What is Credentialing, and how do you complete it?

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Newer physicians may only sometimes be able to answer the question. Credentialing is a way to verify that healthcare professionals are certified. The certification confirms their formal training and their ability to treat patients. To complete the process, extensive paperwork must be filled out, and multiple steps must be followed. The process usually takes 90 to 150 days.

## Credentialing for Medical Practices: Why do you need it?

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Physicians operating any healthcare practice in the United States should discuss credentialing with their colleagues. Medical credentialing could slow a practice’s operations without prompt attention and hamper its ability to treat patients. Physicians answered the following questions when asked what the most significant benefit of medical credentialing was:

- 26 % Quality of services remains consistent/reputation of the field remains intact
- Ensure the safety of patients/prevent malpractice by 26%
- 17% of patients are treated at the highest level
- Confidence is given to patients by 14%
- Maintain staffing levels and simplify the hiring process for physicians
- By 6%, insurance companies will place fewer restrictions on reimbursements
- 4% Reduce loss of revenue/billing issues

Let’s explore a few in greater depth to understand these answers better.

### Reduce Medical Errors

The industry as a whole must be safe and secure. There are approximately 250,000 deaths caused by medical errors each year in the United States. Credentials become even more crucial for medical professionals as a result. In our survey, 26% of physicians believed credentialing protects patients from malpractice and medical errors. More and more Americans are concerned about the safety of their health care, and medical errors can damage your practice’s reputation and undermine your patients’ trust.

### Demonstrate Professionalism

Credentials are one of how you can demonstrate your professional expertise in the medical field. The presence of professionalism reassures patients. Your experience and merit are demonstrated by it. The preservation of the medical profession’s reputation is considered one of the most important benefits of medical credentialing by over a quarter of physicians (26%). Nowadays, physicians can obtain credentials more quickly than ever, while patients are becoming more discerning. As a result, displaying professionalism is a small price to pay in today’s day and age.

### Give Patients Confidence

According to physicians, healthcare credentials are crucial for establishing patient trust. Moreover, trusting your doctor makes it more likely that you will seek treatment proactively and follow your doctor’s instructions. The right credentials lead to better health outcomes for patients. Additionally, it gives other employees confidence that their employer is committed to maintaining the highest standards.

### Maintain Staffing Levels

Physician credentialing delays can harm business and lead to understaffing. Medical credentialing maintains staffing levels, according to physicians. The process could take five months in some states. In most practices, new hires must complete the application process before applying. Professionals should create a new hire credentialing package to streamline the credentialing process. This is crucial as open positions put undue stress on your team and negatively affect patient care.

### Insurance Reimbursement

To get reimbursement from insurance companies, you must be credentialed. 6% of our survey respondents indicated insurance reimbursement as a key benefit. Anyone providing services must be credentialed according to every insurance company in the country. (An additional 4% noted credentialing aided revenue loss.) With this, staff can treat cash-paying patients. Not only private insurance companies but also Medicaid and Medicare require credentialing.

## How to expedite the Medical Credentialing process?

Larger practices may have a team that handles credentialing new hires or outsource to a firm supporting this process. Smaller practices may decide to handle the issue themselves. Whether the institution is large or small, there are steps you can take to make the process easier for everyone and get credentialed faster. Follow these tips to expedite and streamline the process.

## Conclusion

Providers should regularly monitor and analyze their medical billing processes. Billing errors, inefficiencies, and optimization opportunities can be identified this way.

These steps can improve healthcare providers’ medical billing processes, allowing them to provide high-quality healthcare by ensuring timely and accurate payments. The current healthcare credentialing process may be frustrating (91% of physicians believe it should be updated), but healthcare professionals and administrators can streamline it by taking an active role. Getting credentials for the first time makes credentialing easier.

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