medical billing services, medical billing companies, medical billing company, outsourcing medical billing services, healthcare professional, healthcare services, healthcare industry, qualified medical billing, healthcare providers, medical billing service providers, credentialing services, expert medical billing

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!

Healthcare, Healthcare Solutions, MIPS 2019 reporting, Quality Measures in 2019, quality payment program

MIPS 2019 Reporting Is the Future of Quality Healthcare

MIPS 2019 reporting is a progressive path for the qualitative analysis of the healthcare industry. Through the program, CMS ensures the quality of care by measuring the performance of clinicians.

To stand apart from its competitors, P3 Healthcare Solutions is on a mission to promote quality. As proof, Clutch ranks P3Care on their leaders’ matrix. You can also see the names of other successful companies in the health IT sector through this link: 

MIPS 2019 Reporting Requires Critical Thinking

A MIPS Qualified Registry allows only the registry-specific measures; for every submission type, there is a list of acceptable measures.

Merit-Based Incentive Payment System is one of the tracks of the Quality Payment Program (QPP) with the Alternative Payment Model (APM) as the other one. Both of these value-based reimbursement models have their own benefits. To be honest, most eligible clinicians choose MIPS 2019 as their payment model.

Testimonials reports P3 Healthcare Solutions to be one of the leading organizations in medical billing. Reviews are an interpretation of the quality and performance of an organization, and if they are in favor, the company gathers worth.

Founder, SunCoast RHIO, Lou Galterio says, “P3 Healthcare Solutions enables our providers to get paid faster, and they make billing consistent and reliable”.

He continues his interview with Clutch by declaring:

“They’re incredibly responsive, answering my questions on the weekends and at night. We’re a few hours ahead of them, but they still answer our calls, even when it’s early in the morning for them. They’ve also trained some of our internal team to understand their products.”

There is a famous saying, “All is well that ends well”. It means client satisfaction is the only factor that stands between performance and non-performance. If a client is happy, it is the maximum output of a company – the ultimate criterion that matters in the end.

Essentials to Report Quality Measures in 2019

Quality is one of the four performance categories of MIPS 2019. It carries 45% of the weight toward the final score. Contrary to that, it was 50% weight back in 2018.

Why is there a difference?

It is an effort to reduce the burden of MIPS 2019 reporting requirements of eligible clinicians according to the proposed rule.

First, to fulfill the Quality category, ECs have to undergo MIPS 2019 reporting over a span of 12 months.

Second, there are four ways to submit quality measures:

  • Electronic Clinical Quality Measures (eCQMs);
  • MIPS CQMs (Previously “Registry Measures”);
  • Qualified Clinical Data Registry (QCDR) Measures; and
  • Claims-based measures for small practices

Reporting as a Group

With the condition to report as a group of 16 or more clinicians, under the 200 Medicare beneficiaries criteria, the administrative claims-based all-cause readmission measure will automatically count as the seventh measure.

To stay on top of MIPS 2020 reporting, the Qualified Registry option is the most feasible option.

With P3Care as your third-party intermediary, you, as a healthcare professional, can focus on your patients. We become part of your cure to people in distress.

The Case of Specialty Measure Sets

MACRA MIPS never falls short of requirements. ECs, as individuals and groups, have the flexibility to choose between a specialty and subspecialty measure set.

Note: Generally, each eligible clinician is required to submit at least six measures in a specific measure set while CMS Web Interface users have to report all the 10 required quality measures for the full year (January 1 to December 31, 2019).

Value-based care enters the third year successfully and CMS tones down the reporting requirements for clinicians. CMS faces the challenge of physician burnout; they took down some of the measures to reduce their burden. In this way, they can look after their patients in a better way. The lack of patient association and engagement is attributed to difficult EHR handling.

What do you think is a common problem clinicians will likely face in MIPS 2019 reporting?