As a medical practice begins to expand, it is likely that it will begin adding new healthcare providers. This is an incredibly exciting time and while it can be extremely fulfilling to see your business grow, it can also present a tremendous amount of workload from an HR and credentialing perspective.
What is credentialing?
Also called physician credentialing, provider credentialing is the process through which medical organizations verify the credentials of healthcare providers. This is done to ensure that everyone on staff has the required skills, certifications, and licenses that they need to provide care for patients. In addition to provider credentialing, there is also insurance credentialing which is the process of getting a doctor verified so that they can be included as an in-network provider on insurance panels.
The credentialing is required by the federal Centers for Medicare & Medicaid Services and the Joint Commission on Accreditation of Healthcare Organizations and healthcare providers that do not follow the regulations will not be eligible for Medicaid or Medicare reimbursement.
What is the process?
The credentialing process normally occurs in phases. First, a healthcare facility or an insurance company begins to gather basic information on a medical provider in regard to licensing, education, and background. This can be done by contacting the appropriate authorities directly or by using automated credentialing software. They will then see if there have been any malpractice claims or medical incidents involving the medical provider. Once it has been confirmed that their licensing and credentials are valid and up-to-date and that they have a clean professional record, the healthcare facility awards credentials to the medical provider.
How long does it take?
As you can imagine, the credentialing process can take a significant amount of time and can last anywhere between 30 and 90 days. With certain insurance companies, it could even take as long as six months. While the process is already time-consuming, it may even take longer for people who have recently graduated or for anyone that has been involved in a medical malpractice suit. This means that a medical provider is unable to see patients during this time and is unable to get reimbursed for any treatment given to a patient. This can lead to a substantial loss of revenue for both a medical facility and the medical provider.
How can Orchard Medical Management help?
Orchard Medical Management can take a lot of the pain credentialing by completing all applications and necessary paperwork on your behalf with both commercial and government payors. Throughout the process, Orchard will provide status reports for each payor and maintain and update the CAQH profile. Once the process has been completed, they will provide a copy of the fully executed contract and fee schedules to your practice or billing company. This will help you free up valuable time that you and your team can dedicate to your patients. Give us a call at (603) 232-4513 to learn more!