Managed-care companies require that their contracted medical practices and physicians meet credentialing requirements before they begin to service patients. The same goes for hospitals – they, too, require physician credentialing before allowing hospital visits or attending care.
The problem is that contracting and credentialing can be a confusing, difficult, and time-consuming process. Few busy medical practices have the time or resources to focus on this issue.
However, considerable revenue can be lost and time wasted without knowing and following the proper procedures. Below is what you need to know about physician contracting and credentialing.
Contracting Process for Physicians
Most physicians work for a private practice, and many of them also perform contract medical services for one or more hospitals in the area. They also accept managed-care plans and insurance.
Depending on the contract that the doctor signs with the hospital, the doctor may be an employee, an independent contractor, a shareholder, a partner, or some other type of professional relationship with the institution. The contract that the doctor (or practice) signs with a managed-care plan or insurance plan should also be equitable as per the experience and skills they provide to patients.
It is a good idea to have any contract evaluated and analyzed by a medical practice management firm in order to ensure an equitable payment system. It is more difficult to negotiate revisions in a contract than to negotiate a fair contract to begin with.
Credentialing Process for Physicians
Probably the most difficult part of credentialing is gathering all of the required paperwork and supporting documentation. Not only do you need to have certified confirmation of licenses obtained, services provided, and residency programs completed, but you may also have to present information on liability claims and status with the U.S Department of Health and Human Services.
As with most government processes, credentialing is anything but intuitive. In fact, the level of detail required by some institutions and agencies goes well beyond the resources and capabilities of many practices, regardless of their size.
While some practices have the luxury of hiring a full-time staff member or contracting with a high-priced medical consultant, most practices opt for the trial-and-error method. As a result, potential sources of revenue are curtailed or even nonexistent until the credentials are in place.
Turning to the Professionals
Medical practices pride themselves on their level of care and patient satisfaction. Rarely does a medical professional say they would rather gather documentation and navigate government policies over rendering care to patients. The same is true of staff.
The good news is that there are companies that know how to streamline the process. The bad news is that not all of these companies can provide you with the level of detail and knowledge you need to get the proper paperwork done correctly, the first time, in a timely manner.
Medical Practice Management Company
At ProMD Practice Management, we have made it our mission to support all aspects of medical practice management. ProMD will take the headache out of negotiating managed care and insurance contracts, as well as physician credentialing.
For more information about our medical credentialing capabilities, or to learn how outsourcing your medical billing to ProMD can increase your revenue by 20 percent or more within 90 days, contact us for a complimentary consultation. Call us today at (844) 236-5488 or complete our consultation request form. We look forward to helping you maximize your practice – for healthy patients and a healthy bottom line.