Ready to start seeing patients?
You are a doctor or a therapist and you are ready to start seeing patients. Great!
The next step is to think about how your patients will be paying you and your staff for your service.
There are a few clinics that are now taking self-pay or they are offering fee-for-service concierge services, and while this is an emerging trend in healthcare, accepting health insurance benefits as a form of payment is by far the most common. According to the United States Census Bureau, 92.1% of Americans use either private or public health benefits to pay for doctors visits and treatment. This is great news for patients that want to keep their out of pocket healthcare costs low, but it does create administrative work for clinics, doctors and providers in the form of insurance provider credentialing.
Before a clinician can begin treating patients with a specific health insurance as their means of payment, the clinician must be credentialed and accepted into the insurance company’s network. Credentialing is the process of evaluating and confirming a healthcare provider’s qualifications, professional standing, and legitimacy by an insurance company or governmental entity.
This allows the provider to bill the insurance company for a patient’s visit and receive financial reimbursement for services provided.
This can be a long, tedious and complicated process which is why MedTrust Provider Advocates has been helping clinicians navigate this complex system for over 20 years. We have a wealth of experience and knowledge, which is why we are sharing our top three must-know tips before a provider or their staff begins the credentialing process.
Tip #1 Preparation & Patience
The credentialing process typically takes 90-120 days to complete. As such, make sure to begin the process well before you plan to begin seeing patients to avoid delay in receiving payment for your services.
Tip #2 Necessary Information
Before beginning the credentialing process, collect all the necessary documentation and information, including:
- Basic personal information (name, address, contact details, etc.);
- Professional background (CV, education, training, licenses, certifications, etc.); and
- Practice information (address, tax ID, NPI numbers, liability insurance, etc.)
Having all required information organized and readily available is crucial to streamline the application process and prevent delays due to missing documentation.
Tip #3 Get to Know and Understand Your State’s Regulations
Do a bit of research on the front end and become familiar with your state’s credentialing regulations to determine:
- If the state in which you are licensed has reciprocity agreements with other states. This will determine whether or not you may get credentialed in that state;
- If you may bill for services during the credentialing process or if you are required to wait until the process is complete; and
- If there are any recent, relevant changes to state or federal credentialing laws that may affect the credentialing process.
Understanding applicable regulations for your practice and its location will help you navigate the process more effectively and avoid potential compliance pitfalls. By keeping these tips in mind as you begin the credentialing process, you’ll be better prepared to handle the requirements efficiently and get your new providers credentialed as quickly as possible.
Proper Preparation
Proper preparation is paramount to a smooth credentialing experience and effective results. We are dedicated to taking the stress and guesswork out of credentialing which is why we launched our comprehensive guidebook; Credentialing 101. This 25-page book will walk you through everything you need to know about credentialing and will you get to the results you are looking for. Plus, when you purchase your guidebook we will also work with you to schedule a comprehensive, complimentary consultation to answer any follow up questions you may have.
