Administrative complexity is the biggest contributor to overall healthcare waste in the U.S., according to a new study published in the Journal of the American Medical Association.
The study, entitled, “Waste in the US Health Care System,” found that administrative complexity is the leading cause of the estimated nearly $760 billion to $935 billion in total waste annually.
Through a search of 54 peer-reviewed studies, government reports and “gray” literature published from 2012 to 2019, authors of the study determined that administrative complexity was responsible for $265.6 billion in waste annually to the U.S. healthcare system. Payer-provider collaboration is the answer to reducing waste in this category, authors of the study say.
Other areas of waste included: pricing failure, $230 billion to $240 billion; failure of care delivery, $102 billion to $165 billion; over-treatment or low-value care, $75 billion to $101 billion; fraud and abuse, $58 billion to $83 billion; and failure of care coordination, $27 billion to $78 billion.
Therefore, administrative transactions between payers and providers—including credentialing and privileging—definitely contribute to the waste behind administrative complexity.
What we do to reduce administrative complexity:
Generally speaking, Provider Credentialing is a process that supplies insurance companies with information which determines if the provider is qualified to practice, bill, and be compensated for a specific medical service. It’s the first step of, and the foundation for, all your interactions with governmental and private payers. It’s the process insurance companies employ to verify your physician’s licenses, education, background, and other information. We also request contracts and assist the client with rate analysis and contract completion.
Hence, we offer our credentialing service as an integrated part of our coding and billing service. We verify contract status and collate your payer contracts.
  • Verify license, certification, Drug Enforcement Agency ID, and National Provider Identification (NPI).
  • Assist newly licensed clinicians acquire their NPI.
  • Collect and securely maintain supporting documents needed for credentialing applications. For example, driver’s license, birth certificate, Social Security number, diploma, and curriculum vitea.
  • Prepare a separate application packet for every government and commercial insurance carrier plus submit application(s) on your behalf.
  • Follow-up with insurance carriers to verify receipt of applications, respond to additional information requests and track application processing to ensure timely approval.
  • Confirm and Maintain Credential Approvals and Re-credential on provider’s behalf, as needed.
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