5 Important Stats Every Healthcare Organization Should Know About Provider Credentialing

It’s no secret that physician credentialing is critical, involves risk, and is time-consuming. In fact, credentialing is one of the most necessary processes in healthcare to protect patients, providers, and healthcare organizations. Physicians can’t practice medicine or get paid if they aren’t properly credentialed, yet many healthcare organizations still haven’t updated their process. 

So what are some of the risks if your practice still hasn’t upgraded how you credential physicians? Consider these:

1. Healthcare organizations spend about $39 billion annually on administrative tasks for regulatory compliance.

Why this matters: Looking broadly, data from the 2023 CAQH Index found that $89 billion (approximately 22%) of national healthcare spend is spent conducting administrative transactions. Of the $89 billion, the industry can save $18.3 billion by transitioning to fully electronic transactions. This includes provider credentialing. Inefficient credentialing processes hurt your practice’s cash flow. You can significantly reduce these costs by optimizing your credentialing process.

2. Medicare paid out $31.2 billion in improper payments for FY23.

Why this matters: Most improper payments occur when a state, contractor, or provider misses an administrative step, according to the Centers for Medicare & Medicaid Services (CMS). If you’re using outdated tools to manage your provider credentialing, you’re taking on unnecessary risk, including avoidable clawbacks from CMS. On the provider side, you can help prevent these missteps using tools to manage your practice’s compliance and credentialing. 

3. Forty percent of credentialing information found on your providers’ roster is incorrect.

Why this matters: If you’re relying on sticky notes to capture important information, it’s time to update your credentialing processes. A whopping 85% of provider credentialing applications lack critical information. These avoidable errors lead to wasted time, unfilled positions, and delayed payments. Are you maintaining accurate provider data and keeping your team in compliance?

4. Your healthcare organization must comply with 629 regulatory agencies to keep providers properly licensed.

Why this matters: Most organizations rely on Excel sheets to manage licensure compliance, but working this way is exhausting and prone to human error. Digitizing your credentialing process helps you stay in compliance without wasting hours of valuable staff time. Credentialing software solutions can be surprisingly cost-effective — especially considering your time savings and the fines you’ll avoid. 

5. Physicians spend almost 16 hours per week on administrative tasks.

Why this matters: Burnout causes providers to lose enthusiasm for their work, make more errors, and even leave the field. Burnout continues to be an urgent problem, especially in light of the national provider shortage.

Inefficient credentialing processes make burnout even worse. If your practice has chaotic credentialing processes, it’s taking providers away from patient care. You’re also risking preventable oversights that leave physicians and patients in the lurch. 

There is no silver bullet for most challenges in our healthcare system. But in credentialing, technology offers a simple solution that makes provider verification safer, easier, quicker, and more accurate. That means you can reduce administrative burden and give providers more time for patient care. 


How are you protecting your practice? Get started with Modio today.

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