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P3Care Explains the Process of Credentialing – The Easy Way

Medical Credentialing strengthens the reputation of any healthcare professional! It is a process to verify that clinicians have undergone strict scrutiny and practice to acquire the skill of medicine to provide quality healthcare services to patients.

It is also helpful for medical billing services as they can get reimbursements on time without any complications.  The purpose of this process is not just to verify a physician’s degree but to ensure that patients only get services from professionals, whose qualifications, licenses, training, and abilities are acceptable to practice.

Why Healthcare Industry Including the Medical Billing Companies Promotes Credentialing?

Quality of care has taken a central position in the healthcare industry. Therefore, every stakeholder is adopting the latest methods and technologies to comply with new industry standards.

Technology adaptation is inevitable, and we must know that the expertise of the clinicians is equally important. After all, treating patients skillfully also increases the medical practice’s revenue. Thus, we cannot undermine the competence of the medical staff.

Moreover, hospitals have a penchant for credentialing through qualified medical billing services. Thus, every healthcare facility, including ambulatory care centers, long-term care institutions, and even urgent care clinics, don’t hesitate from credentialing.

Medical Credentialing Strengths Relation between Physicians & Patients

Looking into the qualifications of the healthcare professionals creates a sense of trust between patients and healthcare providers, and medical practitioners and medical billing service providers. We have seen many cases in the past when false degree holders were caught treating patients. There is no place for such negligence in today’s world, especially after the pandemic.

This article will take you on the journey of how professional credentialing services are performed. No doubt, the criteria, and function of credentialing have gone complex over time. The provider’s scope of expertise, payers’ requirements and accrediting bodies have to blame for this.

However, an expert medical billing company can solve any issue coming it’s way.

Here is the detailed process of credentialing.

How Credentialing Functions?

Every medical practice should hire a dedicated team or outsourcing medical billing services to ensure that the system runs effectively and the healthcare staff is qualified to perform its duties in a safe environment.

After verifying the individuals’ credentials, the practice license also comes under scrutiny for maximum performance.

  • Verify the practitioners’ clinical degree, training, and performance
  • Verify if a healthcare professional meets the criteria for working in the hospital
  • Establish ground rules for denying verification of professionals after the pre-application process
  • Establish a process to allow the rejected healthcare worker to re-apply after the initial denial
  • Have a process for rapid credentialing of emergency staff and short-term employment staff
  • Limit those healthcare workers who do not follow guidelines or their standard of healthcare is unsatisfactory

Credentialing Helps with Temporary Access to Professionals outside the Practice

In cases when an outside medical or surgical specialist has to offer advice or perform surgery, there should be laws to accommodate them by the medical billing services. In a time of emergency or natural disaster,

proper rules should allow practitioners outside the practice to perform their duties anywhere.

For instance, sometimes, physicians from outside America have to perform a complicated operation because of their different training. In such cases, shadowing or proctoring is required by the host medical practice, and bylaws should be there to smoothen the process.

A proper code of conduct should be in place for healthcare workers who corporate for credentialing and also for those who don’t.

Medical Billing Services Should Encourage their Physicians to Credential their Specifics

Clinicians working in any capacity should understand that practicing medicine is sensitive, and privilege cannot be taken for granted. There is a chance to increase patient volume if you have been credentialed via expert medical billing companies.

Therefore, there is nothing better than accompany your degree with a credentialing certificate.

If you want to boost your revenue and reputation, contact P3Care for professional credentialing help!

5 Hurdles Physician Credentialing Experts Can Help You Avoid

Credentialing specialists and those working to validate doctors in healthcare setups have a huge responsibility on their shoulders to come through as trustworthy partners. Because, if they fall short of certain requirements, not only does it jeopardizes their position but puts physicians’ careers at risk as well.

Medical credentialing is the process of validating and revalidating physicians to be part of a professional healthcare network. Doctors go through re-attestation and revalidation with the help of credentialing experts after they carry it to good effect. P3’s credentialing services make use of rules in favor of physicians so they aren’t penalized in any way.

Overcome the following hurdles with the help of physician credentialing experts.

  1. The Critical Stage of Physician Verification

A new provider who is about to join a hospital needs 60 to 90 days to be fully verified. Once physician credentialing experts give the green signal, the providers start to see the patients. As the process involves microscopic verification related to education, work, past cases, and medical license, a tiny mistake can undermine the process further.

  1. Furnish Peer References on Time

When you have P3 as your medical credentialing service, tenacity to complete the process comes by default. Due to the physician’s busy schedule, it is hard to find time for such matters. Don’t think twice when it comes to hiring trained HIT consultants for credentialing. It makes the job at hand, easier.

Peer references are part of the process but finding spare time to address them and for peers to respond accordingly is the real issue. Don’t fret, because P3 Healthcare Solutions, Ontario, CA has got you covered. We assist you in health IT and credentialing is not any different.

  1. Address Physician Credentialing from Time to Time

The process is not a one-time effort, but a continuous one. For instance, clinicians in ambulatory surgical centers require reevaluation every 1 to 3 years. Constant work is required of their profiles to stay updated.

Since physicians have different portfolio renewal dates, the ASCs have a hard time keeping up with them. Therefore, we, as credentialing specialists, offer healthcare providers the best of solutions. Subscribe to our annual plan at this number 1-844-557-3227 and get rid of the stress forever.

  1. Unified Approach for Patient Health Plans

With the inclusion of the state exchange and federal health plans, credentialing undergoes another knot of complexity. Physician practices, to stay current and updated, have to take up plans of their patients into consideration. There has to be a certain balance between the number of patients visiting practice and revenue generated as a result.

  1. Enrollment with Patient’s Exchange Plan

Due to several stages in the process, the right tactics need to be in place. Otherwise, physicians will experience a delay in payments. For instance, as medical credentialing experts, we make sure physicians enroll with the exchange plan of their patients. As a result, they are paid for rendering services.

Third-party medical credentialing services simplify the process of enrollment and credentialing. Sometimes when trust takes the backseat, it is difficult to rely on outsourcing companies. RCM process improvement comes as an additional perk with P3 as an emerging medical billing service according to a survey by Clutch.co. Discover your true potential to cross the maximum revenue benchmark as we don’t settle for anything less.

About P3 Healthcare Solutions, Ontario, CA:

We are a medical billing company that works for providers while they work for patients. The end-to-end revenue cycle management process activates the true potential of practices. It is an effort to generate for you and utilize the boundaries of the healthcare system in the best interest of physicians and their patients. In the end, every practice deserves high revenue and reduced losses.

Contact Us

P3 Healthcare Solutions, Inc.

Phone – +1 844 557 3227

Get in touch on email – info@p3care.com

Follow us on LinkedIn – https://www.linkedin.com/company/p3-healthcare-solutions

4 Reasons to Outsource Credentialing by a Medical Billing Company

Medical billing companies save revenue cycle management for clinicians. Without the assistance of medical billing services, we doubt the efficient running of medical practice.

The Healthcare industry is quite sensitive and responsible. Physicians are supposed to practice their skills for the ideal health status of individuals. Especially in the on-going approach of the value-based healthcare system, physicians need to modernize their treatment methods now more than ever. Hereby, medical billing companies create medical bills and handle the billing tasks to get the reimbursements. Consequently, physicians can pay attention to their actual work.

However, in addition to the billing process, a professional medical billing company also offers credentialing services for clinicians, which is a vital part of revenue generation.

What is Credentialing?

It is a process, in which hospitals, insurance companies, or healthcare authorities verify and legitimize the educational background, expertise, and qualification of a clinician. Generally, this process takes place before including a physician in the working network.

Why is Credentialing Important?

When physicians are credentialed, they get timely and rightful reimbursements from the insurance companies.

Medical credentialing is not an easy process and requires extensive focus from the start of the process to the end.

No Immature can look into clinicians’ past and derive professional outcomes. The credentialing process is legal and can result in penalties if done unethically. Hence, this responsibility should only be given to medical billing companies.

What are the Challenges that Occur During This Process?

Credentialing Takes Time

Medical billing companies and healthcare industry

Checking one’s background is a complex process. Therefore, it requires at least 60-90 days to fully credential a clinician.

Medical billing services when enlisting a physician for credentialing, are required to complete the whole process before he takes up a new patient. There is no room for error as the process involves the verification of sensitive fields such as employment history, education, medical training, licenses, and more.

Peers Don’t Cooperate

It is obvious that physicians are always tight on their schedule. Hence, there is little possibility that peers, who can give a vote of confidence for the physician will be able to respond to inquiries on time.

To avoid this delay in the credentialing process, physicians can inform their peers prior to the process. Moreover, they can also set a time to complete this task.

No Access to the Latest Information

Physicians need to have access to up-to-date information. However, medical practitioners are so busy in their lives that they remain oblivious of the latest information. For Example,

Clinicians working in the ambulatory surgical centers (ASCs) have to reevaluate their credentials after 1-3 years. When different clinicians have a different schedule for credentialing, it becomes hard for ASCs to manage all.

Thus, no access to the information at the right time creates issues for the credentialing service providers and the confirming authorities.

Inability to be Compliant with Value-Based Healthcare

Different states have different healthcare plans and so physicians are supposed to stay true to all the state exchange and federal healthcare plans.

Another challenge that a credentialing medical billing company faces is that physicians have to treat a reasonable number of patients to handle revenue cycle management. Moreover, medical practices should implement the right healthcare strategies. Otherwise, they’ll not be able to get reimbursements for the rendered services.

Considering the difficulty, medical practitioners choose to outsource for credentialing services. There is no way that unprofessional individuals should not take responsibility for this task. After all, physicians’ revenue generation is based upon it. Thus, only, a medical billing company as P3 Healthcare Solutions can outrun all the above-mentioned challenges for credentialing and insurance enrollment and offer an efficient solution.

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Credentialing Services, Credentialing Services, Healthcare professionals, healthcare providers, healthcare services, Provider Credentialing Process

Overview and Tips For Provider Credentialing Process

Provider credentialing is critical for authenticating expertise, experience, willingness, and interest in providing medical care. If you are not able to follow the provider credentialing process, it can result in delay or worse, denial of the provider payment.

Provider Credentialing Process

It is not one of the formalities that you have to complete or a form that you need to fill. It is an ongoing process that involves a lot of complexities. Therefore, you need to closely follow all the requirements. There are many steps that you need to follow in order to qualify for credentialing. Also, it is essential for your business that you practice without any hindrances.

Besides the simplistic definition, it also involves submitting a lot of documents and forms to various third parties for verifying your practice. You do not need to follow the entire process each year. However, you must provide annual updates.

Some Tips to Keep in Mind When Credentialing

Here are some tips that you need to consider when going for provider credentialing.

Do Not Wait

You can mostly complete the process in three months’ time and take up to five months to complete the entire process. You can no more expedite and shorten the process but abide by the regulations and others’ timelines. The timelines of the payers may vary, so do not wait for initiating the application process.

Be Careful With Requirements

Most of the applicants lack critical data for processing the complete application. Here is what a Credentialing Manager has to say about the state of applicants’ affairs.

“85 percent of applications are missing critical information that is required for processing.” Missing, outdated, or incomplete information is most common in the following four areas:

  • Work history and current work status (include the physician’s effective date with your practice);
  • Malpractice insurance;
  • Hospital privileges and covering colleagues; and
  • Attestations.”

Furthermore, he also points to the fact that applicants can avoid delays by taking care of these small mistakes. Therefore, the applicants must try to get it right the first time.

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Stay Updated on CAQH

CAQH (Council for Affordable Quality Healthcare) has been running its program for the last 18 years. Most of the providers are already following this program. Therefore, the new as well as established physicians, who are adopting this program, have a lot of ease in credentialing and re-credentialing.

Give a Provider’s Start Date

Many healthcare providers remain reluctant when it comes to asking new physicians to submit requisite credentialing paperwork. The health service providers may think of short-term benefits. Therefore, they need to focus on complying with the requirements to avoid any delays or worse, denial of the payments. Furthermore, it is also better for new physicians since they can grow their practice a lot faster.

State Regulations Are Important

The reciprocity and other regulations differ from one state to another. If a physician is credentialed in one state, their credentialing can be updated in another state. However, if a physician moves from one practice to another, they do not require any update to the entire credentialing process. If a physician moves from one state to another and they are not sure about the details, they need to get in touch with their respective Medical Group Management Association. This information will help the physician use the state’s standards to your benefit.

Success Factors to Take Into Account

CAQH Universal Provider has the most comprehensive data source. It is also accepted across the United States as the most detailed credentialing database. By filling their form you will be able to find all the necessary details that you require. However, if you feel tempted to leave some of these fields blank, you are only increasing your chances of rejection. If you fail to realize that, it would be months before you are able to know about the rejection. Once you get the bad news, you would have to provide updates in a very short time. Therefore, it is better to complete the requirements of all the requisites. Do not rely on your memory for estimating dates or other vital clinical data to fill.

Be Careful About the Form Filling Process

Many still believe that it is OK to bill under some other physician’s name when you are waiting for the credentialing process to complete. If you tend to fall for this suggestion, you are subjecting yourself to potentially big legal problems. A lot of the contracts explicitly forbid the physicians to file under someone else’s name. Health providers must also keep a check on the total denials so that they can follow a careful course of action accordingly.

As credentialing and enrollment agents, P3 requires a copy of your National Provider Databank File and requests for credit report information. It is critical to the process of credentialing to run thorough criminal background checks in addition to the procedure of primary source verification. Despite discrepancies, P3 Healthcare Solutions, Ontario, CA assembles a comprehensive case to help you settle down in your new workplace.