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.

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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.

The post Ask The Experts – Credentialing & Provider Enrollment appeared first on MEREM Health.