Below is a list of four significant provider credentialing mistakes that can drive down your practice revenue.

1. Not Planning Enough Time for Credentialing
2. Incomplete or Inaccurate Information on Applications and Documentation
3. Lack of Follow-Up throughout the Application Process
4. CAQH Lapses

Timing is Everything in Credentialing

When bringing on a new provider, time is of the essence. It’s important to take the appropriate amount of time necessary for credentialing, instead of waiting a month before a new physician arrives. You must

• Allow for time to process applications and gain approvals with each payor.
• Take time to review each detail for accuracy and completion prior to submission of application
• Make time to follow up during the credentialing process
• Be timely in re-attesting CAQH profiles.

At a minimum, you must allow at least 90 to 120 days to complete applications and allow enough time to acquire payor approvals so that your new provider can get reimbursed. This projected lead time is necessary for beginning the enrollment process to successfully get a new provider enrolled with individual insurances and facilities.

Not allowing enough time to gather the documentation needed in preparing and processing applications and insurance approvals prior to a physician seeing patients will result in providers unable to bill patients for services rendered.

Keep in mind that the responsiveness of approvals for the individual payor is determined by their workload. Some payors, especially government payors such as Medicare and Medicaid, can take 3-6 months to process.

Attention to Detail is Key to Timely Approvals

Incomplete information and application errors lead to delays in processing applications and possible denials. Applications are commonly denied due to inaccuracy errors such as:

• Omitting or making mistakes on data
• Incomplete lock box address
• Incorrect NPI numbers
• Misspelled Names

Credentialing is directly tied to your profitability. When there are mistakes in the documentation it could hold up applications or to face a denial. This leads to the timely application process to have to start over.

Perform credentialing audits on a regular basis. When was your last credentialing audit?

Persistence Pays Off in Credentialing

Lack of Follow-up throughout the application process can cost your practice 10’s of thousands of dollars just by overlooking one letter or notice. We find that it is too easy for a paper to fall through the cracks, so we do not wait around for your payers to send notice of revalidation/recredentialing, we stay proactive. Be sure to follow up at regular intervals, keep notes and follow up to confirm each application was received.

For example, even though you may have received a fax sent confirmation, one document could have been mis-scanned or lost. Some faxes are not received… so you must always follow through and follow up to confirm the application was received.

Also, keep in mind that most payors will not expedite applications. Most plans will not contact you with updates or reasons for delays.

Update Changes in CAQH Profiles

Every Insurance accesses this CAQH information for credentialing. Profiles need to be re-attested every 120 days. In order to avoid loss in revenue, avoid lapses in CAQH by re-attesting on time and make sure all of the information is accurate and up-to-date. (Including your credentialing contact as well as the individual provider.) Be sure to use contact information that is monitored regularly.

Let MEREM Health Handle Your Credentialing

The day-to-day operation of running a busy medical practice comes with many different challenges. Medical Credentialing is a complex process that can be difficult to manage. Credentialing is one foundational area of the revenue cycle process where mistakes can cost your practice tens of thousands of dollars.

MEREM Healthcare Solutions provides exceptional billing, coding, and medical credentialing services to specialty physicians, hospitals and outpatient centers. Take advantage of our credentialing expertise today! When you trust MEREM Healthcare Solutions, you get the peace-of-mind that your credentialing status is being managed and maintained by our experienced credentialing reps.

While we cannot add more time in the day, we can at least take one of the most time-consuming responsibilities off of your long-running list of day-to-day to dos and we will make sure your practice remains profitable as new physicians come onboard.  Contact MEREM Health today by calling (205) 329-7519 to submit a request for a consultation.

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Credentialing is a complex process that can be difficult to manage. It is easy for a paper to fall through the cracks, so do not wait around for your payers to send notice of revalidation/recredentialing. Stay proactive.

In order to avoid delays in enrollment of your independent diagnostic testing facility, the following mandatory documentation should be readily available so that they can be submitted along with the credentialing:

• Comprehensive liability insurance policy of at least $300,000 per location that covers both the place of business and all customers and employees.
• Current facility state license.  Even if the facility is not required to be licensed by the state, you must provide a current business license.
• Any current applicable accreditation certificates, such as ACR or IAC certificates.
• Name and type of equipment, including the model/serial number, and current software information.
• A copy of the facility’s current W-9.
• Written confirmation from the IRS confirming the facility’s tax identification number and legal business name.
• Voided check or bank letter for EFT enrollment.

Once all the above items are received and the appropriate requirements are met, the credentialing process may begin!

Payors call it different things: Credentialing, validation, contracting, etc, but no matter what they call it, Medical Credentialing is one area of the revenue cycle process where mistakes can cost your practice 10’s of thousands of dollars just by overlooking one letter or notice. Although painfully boring and time-consuming, it is absolutely crucial for every medical practice and independent diagnostic testing facility.

WHY IS MEDICAL CREDENTIALING IMPORTANT?

If you think of revenue cycle management like building a house, payer credentialing is the foundation. If you can’t get the payor credentialing right, you simply can’t get paid. Keeping your credentialing up to date is imperative to getting you paid for your services.

Medical Credentialing is becoming increasingly important because it is the procedure that allows patients to trust their healthcare providers. Through a standardized process that involves data collection, primary source verification, and committee review, patients are assured of their healthcare professional’s merit and experience.

Credentialing new providers for insurance payors and enrolling providers for the facilities they serve is a time-consuming and detailed requirement of every medical practice. Most physicians view this as a necessary evil and find it extremely undesirable. For that reason, they will put off the paperwork until it’s too late. With little time to work through paperwork, problems arise. Common credentialing errors cause scheduling delays, fluctuation in revenue cycle, and much more.

It’s important to take the appropriate amount of time necessary for credentialing, instead of waiting a month before a new physician arrives.

Failure to complete enrollment and submit proper (and often timely) credentials for an individual provider or physician, can lead to a significant revenue loss.

Ask The Experts – Credentialing & Provider Enrollment

Don’t let credentialing overwhelm your practice, causing revenue cycle delays, denied payments, or worse. Get the help you need; hire a healthcare solutions company to manage the medical credentialing process for you.

At MEREM Healthcare Solutions, we would love to help you with the following medical credentialing services:

• Filing applications with Insurance Companies
• Complete application for CAQH (universal credentialing)
• Approval for work comp carriers
• Approval with TPA’s
• Credentialing with hospitals, ambulatory surgery centers
• Credentialing for CMS (Medicare and Medicaid)
• Track updates for all insurance companies, government payers, and work comp carriers
• File malpractice certificates

Are you interested in hiring or outsourcing to a medical credentialing company? If so, contact MEREM Healthcare Solutions today! Feel free to call (205) 329-7519 if you have any questions about our onboarding process or if you are seeking medical credentialing services for your practice.

The post Tips For IDTF Credentialing appeared first on MEREM Health.

On Thursday, MEREM Healthcare Solutions hosted a special guest and credentialing specialist, Matt Waldrep to answer questions and offer crucial advice on provider enrollment. Credentialing new providers for insurance payors and enrolling providers for the facilities they serve is a time-consuming and detailed requirement of every medical practice. Failure to complete enrollment and submit proper (and often timely) credentials for an individual provider or physician, can lead to a significant revenue loss.

As a leader in outsourced Healthcare Solutions, MEREM Health has been providing weekly video tips every Tuesday to help keep the business end of medical operations top of mind for practice owners and administrators. During their first LIVE video, coined #ThinkAboutItThursdays, MEREM Health covered the most frequently asked questions they receive from their clients and prospective clients. (Click Here to watch NOW) They shared information about their unique services and solutions, yet focused on the critical topics that most practice owners face.

MEREM Health Offers Consulting Services

Some of the specific questions covered in the Lunchtime Live Q&A with MEREM Health included:

1. Which payors do you recommend being contracted with?
2. What is CAQH? And Are providers required to have CAQH?
3. What can you do if a provider starts without being fully credentialed?

Matt Waldrep also answered general questions for specialty medical groups looking to add on new providers. Matt offered advice on a projected lead time for beginning the enrollment process to successfully get a new provider enrolled with insurances and facilities. He also discussed specific documentation required and noted that “Not all applications are created equal.”

Lunchtime LIVE Q&A 
Credentialing and Provider Enrollment

If you have questions about the health and productivity of your revenue cycle, feel free to submit questions to MEREM Health through their website. You can even request a Free Consultation and Revenue Cycle Audit.

For more information about MEREM Healthcare Solutions, you can visit their new website. www.MEREMHealth.com. Be sure to Like and Follow MEREM Healthcare Solutions on Facebook.com, in order to be notified of their next Tip Tuesday and Lunchtime LIVE Q&A. Future topic information about the series will be announced soon on their Facebook page, and questions are encouraged to be submitted during the live stream or in advance. Submit your questions here.

MEREM Healthcare Solutions is a Birmingham, AL-based company that has been providing exceptional medical billing and coding services to physician practices and ambulatory surgical centers since 2008.  We pride ourselves on not just maintaining, but exceeding, the level of accountability, communication, and customer service that is valued in traditional, on-site billing departments.

Please check out our other blog posts, or contact us to learn more.

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What Is Medical Auditing?

Medical auditing, like all audits, is the process of examining and reviewing documents and records to ensure accuracy. Medical auditing takes it a step further and examines medical records to ensure that doctors and medical facilities are in compliance with the rules and regulations of the medical field.

Why perform medical auditing?

Medical auditing involves conducting internal or external reviews of coding accuracy, policies, and procedures to ensure you are managing an efficient and clean operation. “Audits are performed not only to ensure compliance but to make sure there is no missed revenue for the provider,” says Lindsey Wingate, Merem Healthcare Solution’s Vice President of Operations. There are several reasons to perform medical audits. Auditing can help protect against fraudulent claims and billing activity, identify problems before challenged with inappropriate coding, identify opportunity for reimbursement, and recognize the use of incorrect codes, just to name a few.

“In my experience, it takes specialized and certified staff to know all the rules and regulations for billing different specialties. When performing an audit for a practice, more often than not I find that charges are being missed due to a lack of knowledge in CPT, AMA, and CMS guidelines,” Wingate explains.

Medical auditing can provide areas of improvement for your coding staff. Even a well-trained staff must be checked, therefore every practice should have an audit performed annually. An audit can recognize under coding, bad unbundling habits, and code overuse. Coding staff will then be able to bill appropriately for documented procedures.

How can we help?

MEREM Health specializes in auditing and can provide education, consultation, reports, and recommendations for improvement. The feedback and recommendations provided by our external auditors are valuable to the improvement of each practice.

Contact Merem Health today to find out how our auditing services will provide support for your practice!

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As a whole, it’s the payer’s role to challenge and manage claims as much as possible, while keeping its subscribers (your patients) happy. Thus, the more they can delay or challenge your claims, the longer the payers can hold the premiums paid by the subscribers. In general terms, the longer the time and the less money the payers have to send you, the more profitable they are. This is simply their job and general fiduciary responsibility to their shareholders.

So, you can see why credentialing is an essential part of revenue cycle management, but how can you best carry it out? Below, we have listed some strategies that we use as a medical billing company. They should help guide you through the messy world of credentialing.

(Learn more about MEREM Health’s services.)

Create Lists

Credentialing is a long and difficult process. Within one practice you may have a number of physicians who need to be in network with multiple insurance companies. Each physician has their own timeline of reauthorizations. Each insurance company has their own timeline for submissions. How do you stay on top of it all? You make lists.

The first list you will want to make will be for the CAQH, the Council for Affordable Quality Healthcare. For many insurances companies, you must be affiliated with CAQH. Unfortunately, this process can take a lengthy amount of time because the application process requires the insurance companies’ involvement. List your physicians who need to be established with the CAQH. Also, list the physicians who are already established, and their dates of establishment.

List all of your physicians and the dates they need license reauthorizations. List all of your insurance companies, their requirements, and the dates they need submissions. Create a to-do list for all the physicians who need to obtain authorizations and/or reauthorizations. Be sure to also note the dates that credentials need to be renewed.

Create A Schedule

With all of the above information clearly written out, you can create a schedule that will lay out tasks throughout the year. Creating this schedule is very detailed work, and is often an ongoing project, but it is the only way to break down the nightmare of credentialing into a smooth and easy process.

Start with your CAQH lists:

• Put in the dates you will submit a physician for CAQH.
• Put in dates to follow up with the insurance companies who have to complete the application.
• Put in dates of re-attestation for physicians who are already affiliated.

Next, add your physician licenses authorizations and insurance submission information:

• Put in dates physicians need to seek renewals
• Put in a few reminders for physician renewals
• Add the timeline of insurance submission information
• Include insurance follow-ups
• Put in insurance reauthorization dates.

As you can see, scheduling for credentialing is imperative but exhausting. It also never ends. Scheduling out the process is the only way to ease the burden of credentialing.

Keep Chugging Away or Hire a Medical Billing Company

Most physicians will tell you, credentialing is a nightmare, and as a medical business company, we understand your pain. The reason we don’t hate it as much as physicians do is that we actually have time to do it. While we stand by our tips listed above, we aren’t going to lie: your schedule will be full. Your best bet is to keep chugging through the schedule crunched for time or to hire a medical billing company.

Failure to stay on top of credentialing could lead to worse scenarios than late payments. It could lead to a physician’s demise, a practice’s closure, or even a patient’s death. This is because one overlooked credentialing error could result in a physician being allowed to practice on a patient without a renewed license. If something were to go wrong, malpractice lawsuits would be at hand.

Don’t let credentialing overwhelm your practice, causing revenue cycle delays, denied payments, or worse. Get the help you need; hire a medical billing company. Contact MEREM Healthcare Solutions today.

The post Revenue Cycle Management: Credentialing (Part 2) appeared first on MEREM Health.

Let’s take a look at what we can expect to see come October 1.

CMS Medical Coding Tests

If we look back to the Center for Medicare and Medicaid Services’ (CMS) June-July testing program, it can be assumed that we are close to ready. Statistics showed that out of 29,286 ICD-10 claims submitted, an outstanding 25,646 were accepted!

The test was designed to see if providers would be able to successfully write and submit the new ICD-10 codes. It also evaluated how successful CMS would be at processing these providers’ claims.

An 87% success rate for such an enormous change is incredibly positive, but what were the common errors?

Basic Mistakes

Most of the rejected claims were invalid because they still contained ICD-9 codes. ICD-10 coding mistakes were the second most prominent reason for a denied claim.

All other mistakes were very minor. These mistakes included an incorrect date, incorrect National Provider Identifiers, and invalid places of services.

While the ICD-10 trial was fairly successful, there were only a small number of providers participating as compared to the number of healthcare practices across the country.

These mistakes will most likely add up and could become overwhelming. In fact, the cause for simple mistakes like an incorrect date could be attributed to the amount of time being spent working on getting the ICD-10 codes correct.

We will likely see very simple mistakes increase as providers become more stressed. There is no doubt time will be taken away from practices as they expend more of their energy on writing perfect ICD-10 claims to ensure their revenue cycle doesn’t experience a hit.

For all of these reasons, it’s important to do one more major assessment of your practice before implementation on October 1. Make sure you have enough time set aside for coding and get all of your unanswered ICD-10 coding questions answered ASAP.

A Better Solution

There are a number of things that could go wrong for your practice if not properly prepared.

The risks could mean a longer wait on payments for your claims. This could damage your working capital.

You might lose time to do very basic things within your office, or more importantly, spend time with your patients.

How can you avoid the risks? Your best bet is to hire a medical coding company.

A medical coding company will have exceptional ICD-10 coding skills. They will be able to file your claims accurately, so you don’t have to worry. In addition to providing you with accurate coding, a medical coding company will also provide you with extra time.

Focus on what counts: your patients. Leave the ICD-10 coding to our professional coders at MEREM Healthcare Solutions. Contact us today.

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