Author Archives: medrevinc

What is Medical Credentialing?

Ensuring a healthcare provider has the proper education, training, certification and credentials not only makes certain that they are qualified to provide care, but it is also integral to being “in-network” with health insurance companies.

Credentialing makes this happen. But what is it and how, exactly, does it work? Here are the details:

Credentialing—The Basics

What is Medical Credentialing?

At its core, credentialing assesses the qualifications of a physician and determines whether or not they are qualified to treat patients. People expect their doctors to be competent, whether they’re seen by them at a doctor’s office or in an operating room, and credentialing ensures that this is true.

The Credentialing Process

The credentialing process involves the collection and evaluation of data on physicians, such as their resume, educational transcripts, work experience, license verifications and more. Credentialing also identifies anyone with disciplinary actions or sanctions against them or any criminal history, and it verifies the accuracy of the documents submitted to the hospital or insurance company. The entire process takes about 60-180 days.

Why Physicians Should Be Credentialed

By proving their qualifications, physicians can then become “in-network.” That is, a physician will be contracted with a health insurance company to provide their services to members for a pre-negotiated price. Being credentialed with the health insurance companies in a physician’s specific geographic location is crucial, as then they will be able to provide care to a much wider number of potential patients. Additionally, by being out-of-network, a physician won’t be paid by the health insurance company, leading to out-of-pocket expenses for the patient.

Credentialing, then, is the first and foremost part to getting “in-network.” To get started, check out Medical Revenue Associate Inc.’s credentialing services, or give us a call at 215-497-1001 today to learn more!

Medical Revenue: Planning Your Service Charges with the Medicare Physician Fee Schedule in Mind

The Medicare Physician Fee Schedule (MPFS) applies to healthcare provider services such as office visits, lab work, types of therapy, surgical procedures and more. It gives providers guidelines on what Medicare will cover for services and how much it will reimburse the provider. Medicare Physician Fee Schedule Rates The rates are determined based on input…

Credentialing Services: Adding or Removing a Physician from Your Carrier Profiles

Being a practice within a managed care carrier network or multiple carrier networks means inevitably having to add or remove a physician from your carrier profile. This process involves an application process (completing the 30-page Council for Affordable Quality Healthcare (CAQH) questionnaire) for a specific network and must be completed whenever there is a provider…

Credentialing Services: Benefits of Joining a Carrier Network

Taking the time to join an established provider network can sound like a huge drain on office resources but doing so can be a major benefit for healthcare providers in the practice, as well as your patients. In-network vs. out-of-network Most patients with insurance have the option of choosing a doctor or healthcare provider that…

What to Know About Credentialing and How Long Does the Process Take?

Being a credentialed practice helps you get “in-network” with insurance companies. Patients will almost always look for providers that readily accept their insurance, as it usually more cost-effective for them and makes the payment process easier. However, becoming a credentialed practice is not necessarily a brief and easy thing to do. The process usually takes…

Questions to Ask Your Medical Billing Staff to Maximize Patient Collections

The goal of any medical billing department is to collect the maximum amount of patient billing. So how do you make sure your staff is doing what they can to maximize revenue for your practice? Is the process clear and straightforward? Creating and documenting a thorough collection process ensures each staff member knows their responsibilities.…

SGR (Sustainable Growth Rate) delays – again!

Why isn’t Congress supporting our healthcare providers? Every year we go through this agonizing time frame of facing a 20% cut in Medicare payments, while Congress constantly bypasses their responsibility. Congress can’t be penalized for their lack of appropriate actions, so they do what is in their best interests. Typical political selfishness. Our government expects our healthcare providers…