Understanding the Process of
Physician Contracting and Credentialing

October 3, 2019

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

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.

To learn more about how ProMD can make your practice run like a well-oiled machine, call 888-622-7498 or fill out our online form to request a billing assessment.

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