The procedure in which an insurance network analyzes your healthcare facility and ensures that all requirements, pre-determined by the insurance company, are being met by the provider is called medical credentialing. Medical credentialing services go through all documents in the USA, including malpractice insurances, background checks, schooling information, and medical licenses. This procedure is done on a single state basis. After the complete analysis, the concerned medical facility becomes affiliated with a particular insurance company and collects reimbursements for its medical services.
The following are some best practices and tips for improved medical credentialing services in the United States of America.
1. TIMELY CREDENENTIALLING:
In the USA, timeframes of medical credentialing services differ from 3-6 months. It all depends on the location and the payer. For instance, more applications are submitted by the doctors at the start of a year, and due to this, it can take five months for medical credentialing. It is significant to remember the longer the waiting time, the more it will influence your practice. That is why it is advised to start early.
2. STAYING UP-TO-DATE:
It is important to ensure that your DEA, malpractice insurance, License, CAQH, etc. are all organized, up-to-date, and accessible. Every year, malpractice expires, so it is crucial to ensure it is up-to-date to assist the medical credentialing procedure.
3. UNDERSTAND YOUR STATE’S CREDENTIALLING REQUIREMENTS:
It is essential to comprehend the medical credentialing requirements for your particular state. Requirements are different for every state. Also, each insurer maintains different regulations. Some companies also demand additional fees, for instance, DMERC, Medicaid, and Medicare.
4. TIMELY CHECKS:
Sometimes, mistakes can be made by the insurance networks. A medical facility needs to stay updated about the procedure, so it can follow up post applying.
5. ACT FAST:
Do not keep waiting until the very last moment. Include providers in your plans. Insurance companies must also be notified of any change is made. The documents should be completely updated before their submission.
6. RE-CREDENTIAL AND REVALIDATE:
If re-credentialing is not done properly, it might hinder the third party’s payment, and it will also consume considerable time for re-validation. Eventually, your practice might lose money throughout the revalidating/re-credentialing procedure if not done promptly.
7. CLOUD-BASED TECHNOLOGY PLATFORM:
Cloud-based technology permits healthcare organizations and providers to avail of healthcare professionals’ data at any time and location. It is not like a client-based server. It stores all information and data. The accessibility is also much affordable and efficient.
8. IMPORTANCE OF FIVE REFERENCES:
The majority of insurance companies require at least three references for starting the process of approval. But it is always recommended that five references should be presented. Five references help in keep the medical credentialing services following the schedule and also prevent delays.
9. AVOID DETAILING ISSUES:
Mostly, 3 out of 4 medical credentialing applications are delayed or rejected by insurance companies in the USA because of the detailing mistakes. It is crucial to provide precise details in your very first submission. The revenue cycle management companies can easily and immediately spot these mistakes, so it is best to steer clear of them.
10. MAINTAIN THE SUSTAINABILITY OF THE CREDENTIALLING PROCESS:
It is difficult to create a medical credentialing workflow in the USA, but it is helpful for a longer period. All required documents and forms should be maintained by your workflow, even if the credentialing procedure is
outsourced.
11. OUTSOURCING THE MEDICAL CREDENTIALLING SERVICE:
By taking the help of a revenue cycle management company, the routine credentialing procedures can be easily navigated and understood. It can also decrease the waiting time by weeks or days, which the medical credentialing process takes in the USA.
12. ASSIGNING A MEDICAL CREDENTIALLING COORDINATOR:
Whether you handle the credentialling tasks in-house or outsource them, it is important to assign a coordinator for this purpose. He/she is meant to be well-aware of all expirations and deadlines to make your business even smarter. The coordinator can also send out well-timed reminders to assist you in making sure that credentialling does not expire, and reimbursements would not be denied because of that.
13. MAINTAINING COMPLETE WORK HISTORY:
In the USA, it is necessary to include all current practices and the previous history of professional work. Other than that, the history and information of the medical practitioner himself/herself should also be included, i.e., date of birth, graduation information, school information, etc.
14. HOSPITAL PRIVILEGES:
It is important in America to admit privileges to any in-network hospital so a medical facility can participate along with a specific health plan. Otherwise, a written admitting arrangement would be required with some other in-network medical physician capable of attesting the agreement.
15. Covering colleagues:
During the medical credentialing procedure in the USA, a medical facility is accountable for delivering coverage to all patients all the time. If you are somewhere else, you must disclose the information of those colleagues who will fill in your duty. Solo practitioners should specifically keep this rule in mind.
We hope this was an informative read for you. For more, check out the other informative articles that we have for you on our website.
