Physician Credentialing: Worth Getting Right to Get Paid

As physicians, despite your reputation for benchmarked medical services, you could be losing out when it comes to realizing medical bills reimbursed fully from respective health insurance carriers. And when you start to analyze that elusive reason responsible for hampering your reimbursements, you would invariably end up discovering ‘Credentialing’ as the chief culprit. Quite contrast to the earlier scenario, wherein your credential as a qualified and competent practitioner could alone determine your practice’s sustenance and growth, the present day scenario, characterized by innumerous practitioners and heterogeneous mix of insurance carriers, requires your practices to bear the stamp of ‘Credentialing’ to stay well clear of audit, delay or denial exposures.

Although, physician practices require to be credentialed from Federal Health Agencies (for being compliant with requisite health care standards) as well as Medicare and Medicaid, and respective private insurance carriers (for being compliant with medical billing standards), it is the latter that assumes greater significance as it has direct impact on operational optimization and revenue maximization. Credentialing in the medical billing context means that your medical practices are compliant with the benchmarked clinical and operational practices as deemed suitable by the prevailing health insurance convention. And as we stand at an important juncture when health insurance sector is realigning its revenue structure post the Federal Government’s radical healthcare reforms, there is a growing emphasis being laid on Credentialing, first by the Centre for Medical Services, and then by private insurance carriers – making it mandatory for physicians to have their practices duly Credentialed.

But, owing to its exhaustive process, Credentialing itself could be one of your major pre-occupation, relegating the all important medical practice to the second! Here are the series of process that would invariably have to clear for being eligible to Credentialing:

•  Preparation of paper CMS 855 & other Managed Care applications for all payers
•  Preparation and submission of online applications to federal and non-government carriers
•  New provider affiliations and Group Contracts
•  Maintaining and updating specific Provider information directly with carriers at frequent intervals or when requested
•  Resolving enrollment issues and tracking Managed Care contracts
•  Validating information provided by payers
•  Handling Provider letter of interest & enrollment transactions
•  Setting of Provider information in the Practice System
•  Obtaining Contracted Fee Schedules and negotiating changes
•  Preparation of contracting documents for scanning and long-term storage electronically
•  Preparing, maintaining and monitoring Managed Care Summaries that Provides Effective dates, Fee Schedule details and Group affiliation.
•  Monitoring Expiry dates for NYS-Registrations, DEAs, and CLIA registrations and also handling re-applications for the same.
•   Handling Re-Credentialing whenever required
• But, because of its inevitability and the incidental benefits that come with a well-documented Credentialing, it is prudent that you outsource from competent and proven medical billing companies that can offer quality services at a more economical cost than it would cost if it done internally. The following overriding advantages should amply justify the efficacy of going for outsourced Credentialing:
•  Insurance carriers pay better to the physicians who are in par with the insurance
•  Credentialed physicians are considered as reliable providers and are listed in the ‘preferred physicians group’ from which patients usually select their physicians in order to get maximum benefits and avoid ‘out of the pocket expenses’.
•  Since physician credentialing involves complete background check on providers’ educational qualifications, professional licenses, experience, fellowship programs, and residence, it helps in controlling the healthcare fraud-related crimes and ensures that only qualified physicians deliver services to patients and thereby improving the quality of healthcare in US
•  Credentialing offers comprehensive access to the fee schedule, which aids in knowing in advance the exact quantum of medical billing for diverse medical practices rendered.
•  Credentialing is also an accelerator of strategic clinical networks and market expansion as your practices begin to command unprecedented goodwill in the medical fraternity.

We, www.medicalbillersandcoders.com – known for offering imperial Credentialing, both as an individual component as well as an integral part of our comprehensive suite for Medical Billing Revenue Cycle Management – should be your preferential choice for “Outsourced Credentialing”.

Paid-sick-days concept as a preventive option for Federal healthcare expenditure

“Coming at a time when Federal Government itself is promulgating radical healthcare reforms to tackle growing medical expenditure on public healthcare, and promote efficient and quality medical care to its ever growing insured population, this paid-sick-days concept promises to complement the macro healthcare reforms formulated by the Federal Health Department.”

 

Strange it might seem, yet there seems to be substance in the thinking that offering employees with paid-sick-days option will eventually bring down Federal healthcare spending on emergency medical services. The logic sources its root to a forthcoming report by the Institute for Women’s Policy Research (IWPR), which estimates that giving employees access to paid sick days would reduce visits to hospital emergency departments (ED) and save $1 billion in medical costs annually; currently public insurance programs support approximately half this bill.

Although the projected saving is roughly around 2% of the total spend of approximately $47 billion annually on emergency department services, there is growing consensus among the policy makers the paid-sick-days option would encourage a proactive and preventive healthcare conscience amongst the employees and their dependents, who otherwise would procrastinate medical visits for seemingly trivial cases that potentially would be more serious. Thus, by encouraging a proactive and preventive healthcare conscience, Federal Healthcare Body can look forward to ensuring a healthy population as well as substantial cumulative savings on public insurance programs such as Medicare, Medicaid, Medicare, Medicaid, SCHIP, and Veteran Affairs Services.

Coming at a time when Federal Government itself is promulgating radical healthcare reforms to tackle growing medical expenditure on public healthcare, and promote efficient and quality medical care to its ever growing insured population, this paid-sick-days concept promises to complement the macro healthcare reforms formulated by the Federal Health Department.

Quite presumably, there would be an additional burden on physicians committed to serve Medicare, Medicaid, SCHIP, and Veteran Affairs Services beneficiaries, who would show propensity to regular medical visits, encouraged by the paid-sick-days concept. Although physicians can count on pay-for-service fees, the potential growing volume would surely put their practices under tight schedule that would render them vulnerable to operational and administrative in-efficiencies. As their practices’ fortunes hinges solely hinges on efficient clinical management and operational management practices, a dedicated clinical management and operational management service becomes crucial. With in-house services failing to match up to the requisite bench-mark, outsourcing seems to be a viable option.

And, when you contemplate on hiring such competent outsourced services, Medicalbillersandbillers.com name should invariably crop up owing to its credible history in being an able ally to a diverse composition of clients comprising Cardiology, Dermatology, ENT, Endocrinology, Family Med, Gastroenterology, Internal Medicine Sub-Specialty, Internal Med,

Long-Term Care, Neurology, Neurosurgery, OB/Gynecology, Occupational Medicine, Orthopedics, Physiotherapy, Pediatrics, Podiatry, Psychiatry, Pulmonology, Rheumatology, Sleep Med, Surgery, Urgent Care, Urology, and the rest.

Therefore, if you are looking at cost-effective yet efficient medical billing and practice management services, Medicalbillersandcoders.com ingenious and comprehensive Revenue Cycle Management – comprising Patient Enrollment, Insurance Enrollment, Scheduling, Insurance Verification, Insurance Authorizations, Charge Entry, Coding, Billing and Reconciling of Accounts, Denial Management & Appeals and Physician Credentialing – should be an ideal choice.

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