Medical Billing Forum

General Category => General Questions => Topic started by: BillingMaster on May 26, 2009, 03:45:42 PM

Title: Credentialing
Post by: BillingMaster on May 26, 2009, 03:45:42 PM
Hi everyone,

I have a client that is asking for credentialing, what is the going rate per hour for this service.  Also, I have been asked to do an audit on some old billing
from their previous billing company.  Should I charge a percentage or flat fee?  Help!!!  ;)
Title: Re: Credentialing
Post by: PMRNC on May 26, 2009, 04:23:12 PM
"Credentialing" is a bit vague. Can you be more specific as to what they want? there are various levels of credentialing.
As for audit's I charge my hourly consulting rate, I wouldn't recommend a percentage of collections on an audit.. ever. it's not ethical. Your hourly rate will depend on your experience as well. I've charged anywhere from $150 to $300 per hour depending on what they want, type of specialty, etc. I perform all my audit's "IN HOUSE" ..again this is for ethical reasons, most practices who want an audit are usually trying to find something or they are preparing for something. This provides peace of mind for them and covers my butt.
Title: Re: Credentialing
Post by: Denise35 on May 26, 2009, 10:10:43 PM
Hello Billing Master,

I have made credentialing a component of my practice management package and I charge $1200 -1800 for small practices and $1500 to $2400 for large practices which is paid in monthly installments.  Because of the "potential" credentialing, contracting issues, and recredentialing opportunities derive within the course of the year in any given practice and I handle them all for the providers I serve.   This a separate contract from coding and billing component.   

However, if you simply wants to charge a one time fee, PMRNC method is a reasonable one. 

I hope this helps,

Title: Re: Credentialing
Post by: dc006 on May 27, 2009, 10:12:52 PM
Hi Denise35:

May I ask where you received your credentialing training or how did you learn all of the steps for credentialing and recredentialing?  It has been hard to locate on-line or off-line training for credentialing.

Also, how did you come up with those practice management package rates?
Title: Re: Credentialing
Post by: BillingMaster on May 28, 2009, 10:14:29 AM
Thanks PMRNC for the good information regarding the credentialing. Now for the next issue.  My client does pain management, does alot of procedures, epis, facets, joint inj. ect. Most patients need an authorization from ins. I have been asked to take on this task.  He says he needs approx. 250 auth's per month, not sure how much per auth to charge.  I'm figuring maybe 15 minutes of time for each auth.  Can you advise me on this.

Phyllis :D
Title: Re: Credentialing
Post by: PMRNC on May 28, 2009, 10:24:14 AM
it depends on what you are charging, if you are billing the client a % of collections it's hard to justify the added fees since auth's are the first phase of reimbursement along with verification and eligibility.  If you are charging per claim, or per service or even hourly then it stands to reason you want to get paid..
250 Auth's is quite a the top of my head if there are 20 work days in a month that's 125 auth's per week 25 per day.  That could take 2 hours or 4 hours depending on the carrier and their guidelines. I had one client that wanted to pay per service as she needed them and I charged $2 per auth, but she didn't have nearly as many as 250 a month.
For all my other clients the fee was built into my percentage. Without that service the full fee was lost so it only made sense to be included in full %.
Title: Re: Credentialing
Post by: BillingMaster on May 28, 2009, 01:29:42 PM
Again, thanks for the advise.  I am charging by percentage of revenue collected, so I think I will up the percentage by two percentage points.  I believe it will be alot of work not to mention the responsibilty.  I've never had a client ask me for this particular service.  Thanks again.

Title: Re: Credentialing
Post by: PMRNC on May 28, 2009, 03:38:52 PM
I should have asked this..but these auth's.. I'm assuming they are initial authorizations? If you will be doing subsequent auth's, you might want to find out if they expect you to turn in the paperwork involved.. the initial authorizations are straight forward to get and you can usually get them when verifying benefits and eligibility, but subsequent ones will sometimes require clinical information.
Title: Re: Credentialing
Post by: BillingMaster on May 28, 2009, 05:41:57 PM
I will be doing both.  I will have remote access to their software in hopes to obtain any clinical info needed.  This is a Florida provider, so lots of discounted plans with M'care/M'caid.  Apparently those types of plans require clinical info. for subsuquent auths and yes I will have to send the info to the ins company and complete any forms they need usually takes 5 days, so they say!!!

Phyllis ::)
Title: Re: Credentialing
Post by: PMRNC on May 28, 2009, 06:12:15 PM
I never did any subsequent auth's where there had to be clinical information sent UNLESS the provider entered and filled out all clinical data.. that's too much liability IMO. When they contract with the managed care plans those are required to be done by them, it's in their contracts aside from the fact that it's "clinical" and best to keep that separate from the billing. What I used to do was provide the provider with a report weekly that showed which patients were in need of subsequent auth's, they would submit the required forms with clinical info and then send me the auth when received, reminding them was the key to having it go smoothly.
Title: Re: Credentialing
Post by: Denise35 on May 29, 2009, 10:22:41 AM
Hello dc006,

My training was strictly from experience as a practice manager and/administrator for several years.  You must learn the ins and outs of credentially because different payers/associations want unique things.  It is not difficult, just time consuming.  A lot of time goes into.  And if you have an organized office, it should go smooth.  However, do count on it.  But if you're having to pursue info, create cv's for the providers and things of sort, it will be a endless task.  However, its a part of my service I do enjoy. 

I hope this helps,