Medical Billing Blog: Section - Physician Credentialing

Archive of all Articles in the Physician Credentialing Section

This is the archive containing links to all articles written in the Physician Credentialing section of our blog.

Click any of the article links below to read the entire article or browse another section to the right to read articles on another subject.

What is physician insurance credentialing?

Physician insurance credentialing, also known as provider credentialing or insurance credentialing, is the process by which healthcare providers, including physicians, nurse practitioners, and other healthcare professionals, become approved participants in insurance networks or panels. Being credentialed with insurance companies is essential for healthcare providers to receive reimbursement for services rendered to patients covered by those insurers.   Here’s an overview of the process: Application Submission: Healthcare providers submit a credentialing application to insurance companies or third-party payers. This application typically includes detailed information about the provider’s education, training, work history, licensure, certifications, malpractice history, and more. Verification of Credentials: Insurance companies or credentialing organizations verify the information provided by the

Published By: Melissa Clark, CCS-P | No Comments

View provider enrollment as a critical part of your RCM

Provider enrollment with payers is crucial, as it ensures proper reimbursement for services rendered, according to Patrick Doyle, senior vice president of Newport Credentialing Solutions. Mr. Doyle shared the following tip with Becker’s Hospital Review: “To ensure every collectible dollar is received, provider enrollment must become an integral part of the revenue cycle process. Best practices should include regular payer audits to validate provider participation status, rigorous payer application follow up, monitoring of licenses and expiring documents, Council for Affordable Quality Healthcare re-attestations and re-enrollments. Furthermore, understand your at-risk revenue against your open enrollments. These are charges billed by providers when their enrollment status is in-process. In-process enrollments for payers

Published By: Melissa Clark, CCS-P | No Comments

Outsourcing a Dirty Word toYou?

The word “outsourcing” has become a dirty word for many physicians that have been burned by medical billing companies that either outsourced their claims to medical billing companies that use neither secure networks nor adhere to HIPAA regulation in order to maximize their profits; or the outsourcing company just turned out to not be reliable and it wound up costing the practice money to utilize their services. Don’t let a bad experience keep you from partnering with a legitimate medical billing company that can not only help you get your reimbursements faster but also realize great profits by maximizing every single medical billing claim that is filed to make sure

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October Updates Are In Effect!

If you haven’t already, make sure that your staff is using the updated CPT codes that were released in October 2008. Not doing so can lead to kick backs that will require more staff hours to research, redo and resubmit and if this happens on a number of claims it can seriously affect your reimbursements and in turn – slow your revenue flow to a mere trickle. One way to avoid this dilemma is to outsource your medical billing and yes, there are some horror stories out there about outsource companies that threw away patient billing, had lax attitudes towards billing submissions and wound up costing the physician a lot

Published By: Melissa Clark, CCS-P | No Comments

Correctly Reporting Wound Length

When a patient reports to the ED and requires laceration repair, the medical billing claim needs to address the length of the wound in order to be a properly filed claim. If the wound length is either not addressed or addressed incorrectly, the claim may be either denied, rejected or only partially paid. Additional factors can include whether or not there was a separate evaluation and how the service was managed during the encounter. Make sure all of these factors are documented in your medical billing claim. Laceration repairs are very common in the ED, in fact a nationwide survey showed that every one in fifteen patients presenting in the

Published By: Melissa Clark, CCS-P | No Comments