Article Side

Online Article Directory!

Hello Guest! Login or Register to submit articles!

Physician Credentialing: Worth Getting Right to Get Paid

By Jacob Thomas Subscribe to RSS | February 1st 2012 | Views:
loading
 
  



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”.

Jacob Thomas - About Author:
Medicalbillersandcoders.com is the largest consortium of Medical Billers and Coders in the United States. We offer Medical Billing, medical billing companies, Revenue Cycle Management

Share on Facebook Tweet It Stumbleupon this post This post is delicious !

Article Source:
http://www.articleside.com/business-articles/physician-credentialing-worth-getting-right-to-get-paid.htm

Related Business Articles Subscribe to RSS

Mistakes to avoid while choosing property management North Shore companies
Published by Jack on August 15th 2012 | Business
Choosing the best property management North Shore company is not an easy task. Learning more about t...
 
Benefits of mail franking for small and large companies
Published by Mr Des on June 22nd 2012 | Business
Franking is very good in technical terms. It can be used to manage the mails. And it can save time a...
 
Easy moving with removal companies
Published by Glyn Jones Is A Renowned SEO Expert Working For Removal Companies Surrey. They Offer Quick And Safe Packaging Surrey Services And on May 12th 2012 | Business
Moving to a new place can be a quite trouble some job. There is need to hire the reputed moving comp...
 
Explore multi benefits of packing and moving companies
Published by Ankita Gupta on February 27th 2012 | Business
Packing and moving is very stressful task for most of us. Shifting from one place to another, make h...
 
Commercial Refrigeration is essential for companies who sell food and drinks
Published by James Blee on June 16th 2012 | Business
For any company that sells food or drinks, commercial refrigeration is a very important consideratio...
 
Moving companies not just for commercial but for residential reallocation
Published by Purushottam Chandra on January 10th 2012 | Business
Moving and packing has become regular core of our life. We are constantly moving from one city to an...
 
Get premium commercial and residential window cleaning services from credible companies
Published by Mithun on April 12th 2012 | Business
You can find professional cleaning services that are designed to keep your home clean and dirt free....
 
IS BIM worth implementing in medium sized companies?
Published by Macjohn on August 25th 2012 | Business
Implementation of Building Information Modeling has not been a major concern with large construction...
 
Medical billing service: Secret behind health care institutes’ top level service
Published by Activemds on April 17th 2012 | Business
Around the world, medical and health care service of United States is appreciated for its quick and ...
 
ISO Certification is essential for companies who wish to compete in both the national and international markets.
Published by James Blee on June 16th 2012 | Business
ISO certification is the International Organisation for Standardisation. ISO certification also mean...
 
Scaffolding companies and their safety instructions
Published by Mobilescaff on April 11th 2012 | Business
They are known all over the world for their prompt, reliable and safe service in each and every aspe...
 
Get Help from PEOs Avail the benefits of the services offered by PEO companies
Published by James Blee on May 16th 2012 | Business
It is not without reasons that more and more organizations are resorting to seek help of PEOs or Pro...
 
Get versatile reallocation services by these innovative companies
Published by Ankita Kumari on January 12th 2012 | Business
Rapid industrialization and commercialization are creating enormous demand for packing and moving co...
 
GH Armor Systems is one of the fastest growing body armor companies, for several reasons!
Published by Thomasgalvin on January 23rd 2012 | Business
There are many companies that handle police supplies and equipment but only a select network of them...
 
Hire professional moving companies to make the process smooth
Published by Ankita Gupta on February 8th 2012 | Business
Packing and moving have become regular part of our life. Bygone are the days when we are struck to t...
 
Gas boiler repair companies, London
Published by Kewinzork on January 11th 2012 | Business
When someone starts living in a house then he/she is very excited and wants to make sure that everyt...
 
Plant hire companies in New Malden and Epsom
Published by Glyn Jones............ on April 18th 2012 | Business
For any construction company a lot of money is spent on hiring of plants. So it becomes very importa...
 
Texas Utility companies offer best prices in the industry
Published by Jordan Adam on March 28th 2012 | Business
The fundamental reason for Texas Utility companies to maintain low prices whether for Business Elect...
 
It is time to hire professional packing and moving companies
Published by Kumari Ankita on January 19th 2012 | Business
Packing from one city to another is the most daunting task we ever have. Fast pace life never allows...
 
How the building companies work at the alteration and additions of a home?
Published by Mark Andysmith on December 8th 2011 | Business
Alteration and additions are the two most common things, preferred in any house when the inmates thi...